A/HRC/14/39 (a) delay in seeking appropriate medical help for an obstetric emergency for reasons of cost, lack of recognition of an emergency, poor education, lack of access to information and gender inequality; (b) delay in reaching an appropriate facility for reasons of distance, infrastructure and transport, and; (c) delay in receiving adequate care when a facility is reached because there are shortages in staff, or because electricity, water or medical supplies are not available.27 When examining the elements of these three delays from a human rights perspective, numerous rights are at play and, consequently, a range of States’ human rights responsibilities may be engaged. 10. When women die in pregnancy or childbirth because the Government fails to use its available resources to take measures necessary to address the preventable causes of maternal death and ensure availability, accessibility, acceptability and good quality of services, the responsibility of the State may be engaged in respect of a violation of women’s right to life. Preventable maternal deaths and injuries may also entail violations of the right to the highest attainable standard of physical and mental health, including sexual and reproductive health, the rights to equality and to non-discrimination and the rights to information, to education and to enjoy the benefits of scientific progress. These rights cannot be seen as absolutely distinct but rather as “indivisible, interdependent, interrelated, and of equal importance for human dignity”.28 11. States are obligated under international human rights law to respect, protect and fulfil human rights in relation to surviving pregnancy and childbirth. These human rights obligations are not only valid in and of themselves, the analysis they foster also contributes to identifying obstacles to more effective public health interventions to eliminate maternal mortality and morbidity. 12. In the context of preventable maternal mortality and morbidity, these obligations require States (a) to refrain from taking actions that would obstruct women’s access to the health-care services they need or to the underlying determinants of health29 (duty to respect), (b) to take measures to prevent women from dying in childbirth and pregnancy (duty to protect) and (c) to take legislative, administrative, and judicial action, including through the commitment of maximum available resources to prevent maternal mortality and morbidity (duty to fulfil). Therefore, States’ human rights obligations include both negative obligations to refrain from action, and positive obligations to act affirmatively to prevent maternal mortality and morbidity, including by taking steps to ensure women can access maternal health care and other relevant sexual and reproductive health services. 13. International human rights treaties and their interpretation by human rights bodies have made clear that many of the obligations States must undertake to prevent maternal mortality and morbidity are of immediate effect. While ICESCR recognizes that many of the rights it guarantees are subject to progressive realization, and requires States to take steps to achieve those rights to the maximum of their available resources, the Covenant also imposes certain core obligations that are of immediate effect. The Committee on Economic, Social and Cultural Rights (CESCR) has emphasized that “a State Party cannot, under any circumstances whatsoever, justify its non-compliance with the core obligations … which 27 28 29 GE.10-12949 UNFPA response to the note verbale, p. 2; report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (A/61/338), para. 21. UNFPA, response to the note verbale, p. 2; A/61/338, para. 21. Maastricht Guidelines on Violations of Economic, Social and Cultural Rights (1997), para. 4. See also: Universal Declaration of Human Rights; Vienna Declaration and Programme of Action (1993), para. 5. On the “underlying determinants of health”, see A/61/338, para. 18. 7