A/HRC/21/22 12. A human rights-based approach is about health and not isolated pathologies; it is premised upon empowering women to claim their rights, and not merely avoiding maternal death or morbidity. Express recognition of the right to health, including a comprehensive understanding of sexual and reproductive health in constitutions and/or legislation, together with accountability mechanisms for the vindication of health rights is essential to a rights-based approach. 13. Measures are required to address the social determinants of women’s health that affect the enjoyment of civil, political, economic, social and cultural rights. In all countries, patterns of maternal mortality and morbidity often reflect power differentials in society and the distribution of power between men and women. Manifested in poverty and income inequality, gender discrimination in law and practice, and marginalization based on ethnicity, race, caste, national origin and other grounds are social determinants that affect multiple rights. 14. States must take all appropriate measures to eliminate discrimination against women, including gender-based violence, forced and early marriage, nutritional taboos, female genital mutilation/cutting and other harmful practices. 9 Maternal mortality and morbidity is a product of discrimination against women, and denial of their human rights, including sexual and reproductive health rights. 15. Human rights require “particular attention to vulnerable or marginalized groups”.10 Among other groups, adolescents, ethnic and racial minorities, indigenous women, women with disabilities, sex workers, HIV-positive women, displaced and waraffected women, women living in underserved areas and other stigmatized and excluded populations should be paid special attention.11 16. Applying a rights-based approach to the reduction of maternal mortality and morbidity depends upon a just, as well as effective, health system. Health systems are more than delivery apparatus for interventions and commodities. A society in which rich and poor women alike – irrespective of race, ethnicity, caste, disability or other characteristic – can rely on the health system to meet their sexual and reproductive health needs fairly is a more just society. In turn, claims for sexual and reproductive health goods, services and information should be understood by health system users, providers and policymakers as fundamental rights, not as commodities to be allocated by the market or matters of charity.12 17. In a human rights framework, women are active agents who are entitled to participate in decisions that affect their sexual and reproductive health. To be effective, participation should enable women to challenge political and other forms of exclusion that prevent them from exercising power over decisions and processes that affect their lives, including their sexual and reproductive health. This requires meaningful participation in the identification of problems, policy design and budget allocation, and the evaluation of programmes and policy implementation. 18. Accountability is not an afterthought in a rights-based approach, but fundamental to each stage of the process – from identifying accountability gaps in a 9 10 11 12 Convention on the Elimination of All Forms of Discrimination against Women, art. 5; Committee on the Elimination of Discrimination against Women, general recommendation No. 14; Committee on Economic, Social and Cultural Rights, general comment No. 14 (E/C.12/2000/4), para. 21. E/C.12/2000/4, para. 43. A/HRC/14/39, paras. 19-21. Lynn Freedman, “Achieving the MDGs: health systems as core social institutions”, Development, vol. 48, No. 1, 2005, pp. 19-24. See also A/HRC/7/11. 5