A/HRC/7/44 page 3 Palestinian pregnant women and limited access to health care. Closures (roadblocks and checkpoints) continue to have economic, medical and psychosocial implications for Palestinian pregnant women as follows: (a) Unpredictable access to maternity services due to restrictions on movement is a determinant in medical decisions on induced labour and caesarean sections and it also discourages women from seeking quality post-natal care; (b) Obstetricians at West Bank hospitals run by the Palestinian Authority (PA) report that complications have increased due to late arrivals after delays at checkpoints and late referrals from private hospitals for caesarean operations free of charge; (c) Mobility restrictions impede continuity of medical care throughout the cycle of pregnancy (prenatal care, a hospital for delivery and post-natal care may not be accessible in the same location) and thus the development of a relationship of trust between medical staff and patients; (d) Palestinian pregnant women and their families live with anxiety and stress, especially during the last period of pregnancy, of not being assured that they will be able to reach a maternity facility and to return home. Transport between the home and the hospital is a constant concern; (e) Studies indicate that physical accessibility to services, in addition to their availability and affordability, is a factor in Palestinian women’s choice of place of birth. According to a Palestinian Central Bureau of Statistics (PCBS) survey carried out in 2004, 20 per cent of women interviewed reported that their childbirth location was not the preferred place of delivery; of those, 13.7 per cent stated that access was impeded by IDF measures; (f) A drastic change in birth location patterns is reported even if this means a lower standard of health care, e.g. an increase in births attended at home or in doctors’ clinics. While eliminating the need for displacement, home births involve high risks if not supported by emergency obstetric care and the ability to access a hospital when needed. In the Occupied Palestinian Territory, emergency obstetric care is limited and access constitutes a vital problem with many roads blocked; (g) Changes in utilization patterns have also had an impact on the quality of services: the higher caseloads in some maternity hospitals were generally not accompanied by an increase in the number of health providers putting further strain on PA hospitals already suffering from understaffing and overcrowding; in Palestine”, International Journal of Gynecology and Obstetrics, vol. 89, issue 2, May 2005, pp. 174-178; Rita Giacaman et al., “The Limitations on Choice: Palestinian Women’s Childbirth Location, Dissatisfaction with the Place of Birth and Determinants”, European Journal of Public Health, vol. 17, No. 1, February 2007, first published online 23 June 2006.