A/HRC/14/39 long-term disabilities (such as prolapse, infertility, obstetric fistula or incontinence) can result.12 For several reasons, pregnancy and childbirth imply higher risks for young adolescents. In developing countries, complications of pregnancy and childbirth are the leading causes of death among girls and women between 15 and 19 years old, with 15 per cent of total maternal deaths worldwide occurring among adolescents.13 6. Five types of obstetric emergencies account for most maternal deaths: haemorrhage (25 per cent); infection/sepsis (15 per cent); unsafe abortion (13 per cent); pre-eclampsia and eclampsia (12 per cent); and prolonged or obstructed labour (8 per cent).14 According to WHO, UNICEF, the World Bank and other stakeholders, the majority of maternal deaths and disabilities could be prevented through access to sufficient care during pregnancy and delivery and effective interventions. This affirmation is supported by the observation that in some countries maternal mortality has been virtually eliminated. Only 15 per cent of pregnancies and childbirths need emergency obstetric care because of complications that are difficult to predict.15 WHO estimates that 88 to 98 per cent of maternal deaths are preventable.16 More recently, UNICEF has reaffirmed that approximately 80 per cent of maternal deaths could be averted if women had access to essential maternity and basic health-care services.17 World Bank estimates show that 74 per cent of maternal deaths could be prevented with increased coverage of professionally delivered interventions, especially access to essential obstetric care, access to safe abortion services, active rather than expectant management in the third stage of labour, and the use of anticonvulsants for women with pre-eclampsia.18 However, the maternal mortality ratio (the number of maternal deaths per 100,000 live births) declined globally at a rate of less than 1 per cent a year between 1990 and 2005.19 The estimated total number of women dying in pregnancy or childbirth per year decreased only slightly between 1990 and 2005 (from 576,000 deaths in 1990 to 536,000 deaths in 2005).20 7. There are large disparities in maternal mortality rates between and within States. Although the majority of maternal deaths occur in developing States, mainly in Africa and South Asia,21 when maternal mortality and morbidity data in developed States are disaggregated, they reveal rates that vary dramatically between different ethnic and socioeconomic communities. Governments in developed States have binding human rights obligations to take measures to address this de facto discrimination. Already in 2001 a report by WHO recognized that “the failure to address preventable maternal disability and death represents one of the greatest social injustices of our times”22 and that “women’s 12 13 14 15 16 17 18 19 20 21 22 GE.10-12949 G. Naanda, K. Switlick and E. Lule, Accelerating Progress towards Achieving the MDG to Improve Maternal Health: A Collection of Promising Approaches (Washington, DC, World Bank, 2005), p. 4. WHO, Women and Health: Today’s Evidence, Tomorrow’s Agenda (Geneva, 2009), p. 31. UNFPA, response to the note verbale, p. 2. www.unicef.org/mdg/maternal.html. WHO, “Maternal mortality: helping women off the road to death”, WHO Chronicle, vol. 40 (1986), pp. 175–183. UNICEF, The State of the World’s Children 2009: Maternal and Newborn Health (United Nations publication, Sales No. E.09.XX.1), p. 2. A. Wagstaff and M. Claeson, The Millennium Development Goals for Health: Rising to the Challenges (Washington, DC, World Bank, 2004), pp. xi, 6, 51 and 52. WHO, Maternal Mortality in 2005, p. 2. Ibid., p. 17. Ibid., p. 15. R.J. Cook, B.M. Dickens and others, Advancing Safe Motherhood through Human Rights (Geneva, WHO, 2001), p. 5. 5