Padaviya

At first glance, Provisional Measure 557 (PM 557) is not a bad law. It purports to address Brazil’s high maternal mortality ratio by ensuring better access to quality maternal health care, notably for pregnant women at a high risk for health complications. The problem is that it won’t reduce maternal mortality. Notwithstanding the fact that many of its provisions are legally and constitutionally questionable, its requirements are not based on sound public health policy.

So what is going on? Brazil, the most populous Catholic country in Latin America, finds its politics intrinsically tied to the hierarchy of the Catholic Church. Dilma, who won a last-minute reprieve from the church’s negative onslaught in the 2010 presidential elections once she disavowed any suggested support for abortion, is to a certain extent beholden to that base. Indeed, Dilma’s cabinet includes an unofficial church representative who was responsible for brokering an agreement between the Vatican and Brazil during President Luiz Inácio Lula da Silva’s administration. For years Catholic and evangelical parliamentarians have been trying unsuccessfully to establish a registry for pregnant women, with Dilma’s support they’ve finally succeeded.

Passing such a controversial law during the height of the holiday season without congressional review or approval suggests some backroom negotiations were at play. A provisionary measure is a legislative tool available to Brazilian presidents to pass a law without congressional authorization and is intended for urgent matters. Congress can only debate and approve the law once it has been enacted. While maternal mortality is absolutely a pressing issue, PM 557 is a law that requires long-term implementation to address an endemic issue; therefore, it clearly does not fall into that category.

The biggest problem with maternal mortality in Brazil is not access to health care services, which PM 557 claims it will address, but rather the quality of public health services. The majority of preventable maternal deaths actually take place in public hospitals. PM 557 does not guarantee, for example, access to health exams, timely diagnosis, providers trained in obstetric emergency care, or immediate transfers to better facilities. It doesn’t even ensure a pregnant woman will find a vacant bed when she is ready to give birth.

What PM 557 does do is raise questions about preserving a woman’s human rights: her right to privacy, which would be violated by the compulsory government registration to control and monitor her reproductive life; her right to autonomy and dignity, which would be violated by denying her the freedom of choice; and her right to liberty, which would be completely void as she’d be legally obligated to have all the children she conceives (protecting the rights of the “unborn,” which is flagrantly unconstitutional) and will be monitored by the state for this purpose.

It’s unlikely that Congress will review the new law until it next meets in March. In the meantime, it’s unclear whether women will be lining up to register their pregnancies and if they do what will be the consequence of a pregnancy that ends in miscarriage or an abortion—the latter of which, under Brazilian law, is criminalized except for cases of rape or risk to the life of the pregnant woman. One thing we can be certain of is that maternal mortality rates will not be dropping any time soon, but the prosecution of women for harming a fetus or for getting an abortion could be on the rise.  

By Gillian Kane

Amnesty International’s Maternal Death Clock has only been ticking for a week, but it’s already passed 8,000 deaths. Around the world, a woman dies in childbirth every 90 seconds, and the Maternal Death Clock is keeping count. Even if you’re a speedy reader, you can expect at least one woman will be counted by the time you finish this blog post. All it takes is a minute-and-a-half. At the end of a year, the tally will be up at 358,000.

Countries agreed to decrease maternal mortality rates by 75 percent in 1990 as part of the UN’s Millennium Development Goals - a set of targets aimed at improving social indicators in developing countries.

In India, where a chronic lack of health care infrastructure and awareness mean millions of women in villages give birth at homes with little medical help, maternal mortality rate (MMR) has halved to 254 per 100,000 births since 1990.

It needs to fall below 140 to meet the 2015 target.

Mariam was too weak to whisper, but about to give birth. For days, she had travelled in a donkey cart from her native Sudan to the health centre of a refugee camp in eastern Chad. She arrived fully dilated, anaemic and low on blood. Before long, she exchanged her life for the baby daughter she would never meet.

There was no need for Mariam to die giving birth. An antenatal consultation at the health centre could have provided the anti-anaemia medication and supplementary feeding that would have saved her life.

Progress in reducing maternal mortality and morbidity is still “tragically slow”. Now, the United Nations has unveiled a global initiative based on government, civil society and private sector cooperation that could save the lives of up to one million women during pregnancy and childbirth.

AMNESTY INTERNATIONAL - Amnesty International has called on US President Barack Obama to tackle soaring rates of maternal mortality and pregnancy-related complications that particularly affect minorities and those living in poverty. In it´s report Deadly Delivery: The Maternal Health Care Crisis in the USA, urges action to tackle a crisis that sees between two and three women die every day during pregnancy and childbirth in the USA.