Creating A Circle of Accountability for the Prevention of Maternal Mortality and Morbidity: Recent Developments at the United Nations Alicia Ely Yamin, JD MPH Lecturer on Global Health, and Director, Health Rights of Women and Children Program

UN Technical Guidance General principles Planning and Budgeting Ensuring Implementation Accountability [International assistance and Cooperation]

Background Thematic Report (A/HRC/14/39) Best Practices Report (A/HRC/18/27) 2012: “Technical Guidance on the Application of a Human Rights Based Approach to the Implementation of Policies and Programmes for the Reduction of Preventable Maternal Mortality and Morbidity” (Technical Guidance). (A/HRC/21/22)

Technical Guidance: General Principles HRBA to health, not MMM Social determinants of SRH Health Systems Accountability Non-discrimination/equality Participation Transparency

Planning and Budgeting National Plan of Action on SRH Multi-sectoral Based on situational analysis Transparent and participatory process Review of legal and policy framework Redressing historic patterns of discrimination; special concern for marginalized and vulnerable groups

Budgeting “Maximum available resources” Confers added protection If budget increases… If budget decreases… Low-income populations

Ensuring Implementation Bottom-up diagnostic exercise (what,? where?, to whom?, why?, who,? how?) Two examples: Women arriving late or failing to seek EmOC Adolescent MMM

Example of identified problem: women arriving late or failing to seek emergency obstetric care

In a HRBA… Proximate and underlying factors Health workers Accountability requires follow-up

Accountability (1): Monitoring Laws, policy, and budgetary efforts, results (inputs, outputs, outcomes) Quantitative indicators should facilitate drawing conclusions with respect to international obligations: comparable, objective; programmatically relevant; subject to disaggregation, local audit; frequently or continuously measurable (Yamin and Falb, 2012) Should facilitate strengthening the health system, including the health information system. Monitoring encompasses private actors.

Accountability (2): Forms of Review/Levels of Accountability Administrative, Social, Political, National legal accountability, International accountability Professional, Institutional, Health system, Private actors, Donors

Accountability (3): Remedies Ensuring Implementation of Laws and Policies Reforming laws, policies and budgets Challenging discriminatory barriers Redress for violations of SRH rights in practice

Concluding Reflections Implementation report in 2 years Post 2015