A/HRC/45/19 each year.24 For every woman who dies of pregnancy-related causes, it is estimated that 20 to 30 others experience acute or chronic morbidity, often permanent, undermining their health and well-being.25 Consistent with rates of maternal mortality, maternal morbidity rates are estimated to be highest in low- and middle-income countries, with a higher prevalence of maternal morbidities among marginalized women. 41. Looking only at maternal mortality rates to assess a country’s progress in the area of maternal health overlooks the importance of maternal morbidity, which is not only a precursor to maternal mortality but also carries the potential of long-term negative impacts on women’s health and quality of life. In the available research, maternal deaths have been described as “the tip of the iceberg and maternal morbidity as the base”.26 A human rightsbased approach to maternal health necessitates increased attention to maternal morbidities in order to uphold a wide variety of human rights for women and girls. B. Maternal morbidity and human rights 42. The impact of maternal morbidity on the human rights of women and girls is significant. Human rights bodies have consistently recognized that maternal health is a matter of human rights, in particular highlighting the rights to health, privacy, education and an effective remedy, as well as the prohibition of discrimination and torture and other forms of cruel, inhumane or degrading treatment, among others. They have also made it clear that maternal health services, which include services to prevent and treat maternal morbidities, must be of good quality, available, accessible and acceptable to all pregnant women and girls, and provided without discrimination. A human rights-based approach to maternal morbidities is premised on the principles of accountability, participation, transparency, empowerment, sustainability, international assistance and non-discrimination. Applying a human rights-based approach to maternal morbidities will (a) support efforts to empower women to claim their rights, (b) address factors such as discriminatory laws, policies and practices, as well as underlying determinants of health, which heighten risks of maternal morbidities, (c) identify gaps in service provision, treatment and prevention, and (d) establish systems of accountability to respond to human rights violations. C. Maternal morbidities in focus 43. The term maternal morbidity captures a wide range of conditions, which cannot be described in detail in the present report. The four illustrative examples of maternal morbidities listed below are included in the analysis because the human rights dimensions of their causes and consequences are particularly salient. These are also some of the maternal morbidities for which more robust data and research exists, enabling a fuller analysis. 1. Obstetric fistula 44. Obstetric fistula can be a serious and devastating lifelong condition if left untreated, with severe medical, social, psychological and economic consequences. It is described “as an abnormal opening between the vagina and the bladder or rectum, leading to continuous urinary or faecal incontinence”.27 45. Prolonged, obstructed labour without access to timely, high-quality medical treatment causes the vast majority of obstetric fistula cases worldwide. With access to quality maternal health care, obstetric fistula is largely preventable. It is estimated that, 24 25 26 27 10 Marge Koblinsky and others, “Maternal morbidity and disability and their consequences: neglected agenda in maternal health”, Journal of Health, Population and Nutrition, vol. 30, No. 2 (2012). Firoz and others, “Measuring maternal health”, p. 794. Ibid. See www.who.int/reproductivehealth/topics/maternal_perinatal/fistula/en/.