A/HRC/23/37 increasing from 59 per cent of children in the early to mid 1990s to 83 per cent in 2010 in the 19 completion point HIPCs for which data are available.30 31. In Mauritania and Bolivia (Plurinational State of), attended births increased from 40 per cent to 60 and 70 per cent, respectively, presumably after funds from debt relief were directed to the health sector. In Benin, Bolivia (Plurinational State of), Sao Tome and Principe and the United Republic of Tanzania, debt relief savings were used to fund schemes to educate mothers about nutrition and family planning. Similarly, Benin and Niger used savings from debt relief to increase access to water. 32. To the extent that it can be established that such increase in public expenditure is attributable to increased fiscal space provided by debt relief, it can be argued that debt relief has contributed to enhancing the conditions for the realization of human rights, such as the rights to health, education, water and sanitation. Nevertheless, as the example of the Plurinational State of Bolivia (see paras. 17-18 above) shows, causality is difficult to establish. The problem is compounded by the fact that many recipient countries do not have specific systems to manage and track spending from debt relief savings. IV. Limitations of current debt relief initiatives 33. The existing debt relief schemes have a number of shortcomings which, according to one commentator, appear to indicate that they have “not been quite as successful as claimed by the IMF and World Bank.” 31 A. Creditor dominance 34. A major criticism of the initiatives is that they are entirely creditor-driven and that impoverished countries overburdened with debt have no choice but to accept the onerous conditions imposed by creditors even where these are clearly not in their national interest. With respect to debt sustainability assessments conducted by the World Bank and IMF, for example, it has been asserted that given that these institutions are “the single most important creditors – in quantitative or qualitative terms or both – to most [...] debtor countries [...], the recovery value of these institution’s claims depends directly or indirectly on their own assessment.”32 35. In the Independent Expert’s opinion, creditor dominance of the existing debt relief mechanisms is inconsistent with the principle of shared responsibility of creditors and debtors for preventing and resolving unsustainable debt situations. B. A rigid definition of debt sustainability 36. One of the most contested elements of current international debt relief initiatives is the notion of “debt sustainability,” which has been defined narrowly by creditors according to the ability of debtor countries to repay their debts in terms of their export earnings. 30 31 32 See IDA and IMF, “HIPC Initiative and MDRI Initiative: Status of implementation and proposals for the future of the HIPC Initiative,” 8 November 2011. Sarajuddin Isar, “Was the Highly Indebted Poor Countries Initiative (HIPC) a Success?”, Consilience: The Journal of Sustainable Development, vol. 9, Iss. 1 (2012), pp. 107-122. See Jürgen Kaiser, “Commentary on IMF/World Bank: Revisiting the Debt Sustainability Framework for Low-Income Countries,” erlassjahr.de Working Paper (Updated version), 9 February 2012, p. 1. 11