Akram fazlikhany (Graduate master of studies in Middle East)
Human rights have a global aspect and Should be used, regardless of any discrimination, including gender discrimination. Women’s rights have different dimensions, Including it’s the health of them during pregnancy. Daily per minute, in a corner of the world, Woman due to pregnancy problems and giving birth loses her life, this is a health issue and is caused by social injustice. Although, since the 1940s, it has been trying to improve the status of women’s rights, especially during pregnancy, but the problem is still there, especially in developed countries and women do not have pregnancy health and in many cases, the mother’s death occurs during pregnancy or childbirth. This article is an attempt to be paid to this topic how much extent has been addressed in human rights, and how much women feel secure during pregnancy.
Pregnant women, Human rights, Women’s health, Millennium development, Non-discrimination
With the end of the Second World War, that the individual was recognized as the subject of international law and especially in recent decades a global movement for more emphasis on Issues related to Economic, Social and Cultural Rights (Second Generation of Human Rights) and the collective right (the right to development, the right to live in peace and the right to a healthy environment), which is the third generation of human rights, and emphasizes the inseparability of these rights from civil and political rights (the first generation of human rights) In the meantime, attention has been given to the fundamental human rights and fundamental freedoms of individuals has been restored. Also, the demand for attention to women’s human rights has led to issues related to human rights are discussed more comprehensively and more widely and protesting the greedy concepts of the human rights in which women’s lives are considered to be human rights issues has begun. But whether in practice these methods, and has led to a practical improvement in the status of women in the world, cannot say with certainty; because the reports and documentation published by various United Nations agencies on the status of women in the world, speaks to the bitter fact that Long story, repetition, sad, boring and continuous violations of women’s human rights continue to persist. Violations of women’s rights can be studied from various dimensions. Including: the rights of women workers, domestic violence against women, sexual abuse of women, Political and social participation of women and … One of these is the rights of pregnant women and their health during pregnancy. According to statistics released by the United Nations, Women’s health is very vulnerable in most countries. Therefore, this is considered as one of the developmental indicators of the countries that the main emphasis is on promoting and strengthening the role of women in achieving optimal health and promote their status in the health care system of the countries. This article tries to address this question: Do the safety and health of pregnant women been observed? Hypothesis: Despite the emphasis that has been in international congresses, On the health and rights of women during pregnancy, women during in this period are exposed to a variety of dangers and illnesses and there are no solutions to their health.
Pregnant women’s rights from the perspective of international organizations
At different times and in various international conventions and programs on women’s rights from different dimensions has been discussed and investigate Below are some of the following:
1/ United Nations Charter
On June 26, 1945, the United Nations Charter in San Francisco, at the end of the UN conference, it was signed and came into force on October 24th of that year. In the introduction of the charter, such is stated: By reaffirming our faith in the fundamental human rights and the dignity and value of human personality. In addition, a number of Charter articles emphasize that the United Nations, it will develop and facilitate the universal respect for human rights and fundamental freedoms for all, without discrimination on grounds of race, gender, language or religion. (Bigdeli, 2011: 257).
2/ Cairo Strategic Plan
The Cairo Strategic Plan was adopted in 1994 at the International Conference on Population and Development in Cairo. This independent strategic plan emphasized that Government to fix fertility needs of individuals and not merely to population objectives It is responsible and recommended that family planning services in the field of other reproductive health services, including services for health and safe childbirth, caring for sexually infections and post-abortion care is also provide. The Cairo program is the first international policy document to define reproductive health, which states: “Reproductive health is a state of complete physical health, mental and social well-being and not just the absence of illness or disability, in all matters relating to the reproductive system or its function and processes. Reproductive health therefore implies that People can have a satisfying and safe sex life and procreation ability and freedom of decision making about when and how many times do they have babies. About the recent condition of the rights of women and men that about access to secure, affordable and acceptable family planning of their choice, have enough information. Also, the right to access to other methods of family planning that is not in conflict with the law. The right to use appropriate health services that enables women to take pregnancy and childbirth safely and providing the best conditions for having a healthy baby for all couples The Cairo Strategic Plan was agreed upon by 184 UN member countries. However, many Latin American and Islamic countries, constraints on reproductive rights, sexual freedom, abortion and all programs that have potential conflict with the laws of Islamic countries, were discussed. (Lyman and others, 2014: 37).
3/ Beijing policy
In 1995, the Fourth World Women’s Congress, held in Beijing, in an independent statement and strategic policy, supported the Fertility Health Program and its areas of concern in Cairo, however, it provided a more comprehensive definition of reproductive rights: The human rights of women, including the right to manage and decide freely and responsibly all sexual affairs related to them, including sexual and reproductive health without any coercion, discrimination and violence. Justice in the relations between women and men in the areas of sexual and reproductive includes respect for personal integrity, the need for mutual respect, the consent of individuals to sexual behavior and the division of responsibility and its consequences.
In Beijing’s policy, twelve critical attributes are identified in the human rights of women who need protection. In this policy, Women’s reproductive rights has been formulated as an inalienable and undeniable universal right. (Same as: 37)
4/The Universal Declaration of Human Rights
This announcement is one of the first documents that has addressed women’s rights and family rights and in that 6 times the family is repeated. Since the issuance of the Universal Declaration of Human Rights has been the subject of a recommendation, the countries that adopted the Declaration of Human Rights sought to achieve by the two international treaties Political and economic rights, social rights, give an executive to the implications of the Declaration of Human Rights. Covenant on Civil and Political Rights in Article 3 The benefits of gender equality refers to all the rights contained in this Covenant. Also, in clause 5 of article 6 protects pregnant women against the death sentence.
5/United Nations General Assembly
United Nations General Assembly in 1989 during the resolution, named 1994 as the International Year of the Family and the slogan of the smallest democracy in society was chosen for it. To strengthen and support the family, Some UN pillars have obvious contact with the family including the United Nations Population Fund, which promotes a safe and secure mother and to regain health emphasizing to fix the needs of young people and Pay attention to emphasizes gender equality and eliminating the risk of AIDS and also can be mentioned to United Nations Children’s Fund.
6/Millennium Development Declaration
In 2000, 189 countries committed themselves to ending poverty through the achievement of the Millennium Development Goals. Fifth Development Plan (Maternal Health Improvement) It was summarized reducing maternal mortality by 75 percent by the year 2015, In 2007, world leaders also incorporated another purpose in it and that was global access to reproductive health. (World Health Organization 2010: 3)
7/ International Federation of Family Planning
In 2004, the International Federation of Family Planning The promotion of the 12th right as an international reproductive health right is on its agenda that the right to life is the most important of them. That is the life of no woman should not be at risk due to pregnancy, childbirth or related fertility. Almost all cases of mother’s death occurs in developing countries, especially in poorer and more vulnerable groups. In fact mother’s death reveals one of the biggest inequities in the health sector between poor and rich countries as well as between the poor and the rich is Stays in a country. Therefore, for the purpose of attracting support through the attention of governments it’s a good indication of the vast challenges facing them and the healthy maternity program. This indicator shows the extent of the problem of maternal mortality in the country and it’s as a stimulus for action. It also helps determine the priorities. (World Health Organization, 2006: 13)
8/International Labor Organization (ILO)
One of the international documents that spoke about the rights of pregnant women and their employment during pregnancy is the International Labor Organization, which today has the largest share of women’s employment support. In general we can say that the characteristics of the conventions and declarations on women’s rights and gender non-discrimination, are as follows:
A/ Condemning discrimination as the root of gender inequality;
B/ Identifying broad areas of discrimination against women;
C/ Moving towards practical measures to condemn and eliminate discrimination through various mechanisms;
One of the important points of this convention is to investigate issues such as family relationships and rural women who were not previously subject to international law. Governments joined it very quickly with other international human rights instruments.
Women’s reproductive health
General health is one of the concepts that is of particular importance today and its circle becomes more common every day. The lack of reconciliation and the existence of behavioral disorders in human societies is very evident and abundant and on each class of the Union and every collective, unbalanced people are living. Having mental balance depends on several factors The most important of these are feeling safe, efficient and valuable, lack of anxiety and depression, high social performance, and physical and mental health and wellbeing. People who have problems with nervous and psychological problems are anxious, depressed, uncertain, inadvertent and inundated and the continuation of these disorders may interfere with personality and problems such as confusion and distress of thought, and lack of concentration of attention, and reduced learning ability and disorder in the performance of the person be created. (Nacroe, 2004) Pregnancy is one of the major stressors of life which can be revealed or exacerbate the cause of depression. In the event of marital problems, unwanted pregnancy, a personal or family history of depression and a low socioeconomic status, the risk of developing depression increases. ( Smith and colleagues 2004) Mental Health Survey can develop strategies and patterns to improve the quality of life and increasing adaptive behaviors and fight the most threatening factors to provide health and, consequently, to carry out health plans and preventive measures in education. Maternal health care during pregnancy and preventing worries, anxieties and psychological pressures, and training to familiarize them with adaptive mechanisms, reduces irreparable losses that may result from the slightest negligence in this period. In 1994, at the International Conference on Population and Development in Cairo, reproductive health was considered as human right. Representatives from 180 countries participating in the conference announced their goal was to make public access to reproductive health information and services by 2015. As long as these rights are forgotten, every year, millions of people will face illness, injustice, disability and death. The victims of this deprivation are mainly women in developing countries. Reproductive rights are considered a set of rights following:
1/ The right to life: The life of any woman should not be at risk due to her pregnancy or relevance to her fertility.
2/The right to liberty and individual security: No woman should be subjected to surgical treatment by force which causes genital mutilation, sterilization, abortion and other similar threats.
3/ The right to justice and free from discrimination: All human beings are equal. Reproductive health services should be provided equally to anyone, regardless of race, ethnicity, skin color, income level, gender, marital status, physical condition, age, language, religion, and political beliefs.
4/ Right to privacy: All health services should be provided confidentially and all women have the right to decide independently on their reproductive health issues.
5/ The right to freedom of thought: Concepts and customs should not be considered as tools to restrict freedom of thought in reproductive health issues.
6/ The right of access to facilities and training: Everyone should have access to information and education on the benefits, disadvantages, risks and effectiveness of all contraceptive methods so that they can make informed decisions.
7/ The right to individual decision about marriage and family formation: Everyone has the right to decide on the time of marriage and the formation of her family and no one has the right to impose marriage on anyone (especially the youth).
8/ The right to make individual decisions about the number and date of birth of children: Everyone has the right to decide on the number and timing of the birth of their children, and they must provide infertility facilities for couples who wish to have children.
9/ The right to access services and the highest quality of services: No limitations and barriers should have existed to providing fertility services or prevent from pregnancy to applicants and services must be available for all segments of society (including youth), with any kind of legal request.
10/ The right to benefit from scientific progress: Referents to Health Centers they should be able to use the latest and most effective and safe methods.
11/ Freedom of participation in communities and political participation: Everyone has the right to participate and group membership, ask for government and nongovernmental assemblies that put reproductive health and rights priority in their activities.
12/ the Rights to freedom from torture and ill-treatment: It is the right of all men and women to be protected from violence, torture and sexual harassment. (Karami, 2015: 85)
The term maternal death refers to the death of women during pregnancy, or 42 days after the end of pregnancy, with any cause associated with pregnancy, exacerbated by pregnancy or caring provided during it, but not due to an accident. (Slamlou, 2006). Mother’s death is considered unacceptable because it is preventable in the majority of cases. Such a death is due to the inability of the health system and the unequal access of clients to financial, educational and primary health care. (Cook and Dickens, 2007)
Analysts believe ignoring maternal preventable deaths is a violation of human rights and a part of the phenomenon of discrimination against women. (Cook & Plata, 1994) In 1995 , the world’s maternal mortality rate was estimated at 515000. In the year 2000, this figure reached 519,000.
Maternal mortality in pregnancy, or within forty-two days after the termination of pregnancy, irrespective of the cause of death are divided into two groups:
-Mother’s direct mortality: Includes maternal deaths due to complications of obstetrics, pregnancy, delivery or postpartum period, interventions, negligence, ill-treatment and misconduct. Such as death from postpartum hemorrhage.
-Mother’s indirect mortality: Including maternal deaths due to heart disease mother, or illnesses during pregnancy, childbirth and after that appear or are exacerbated. For example, pregnant mother died as a result of diabetic coma or a pregnant mother who is suffering from mumps or an influenza virus.
– Mother’s death with delay: If the mother died causes, directly or indirectly, within forty-two days after the termination of pregnancy up to a year .(shamshiry milany 2012: 1656-1657)
Of the total maternal mortality due to pregnancy and childbirth complications four thousand cases in advanced countries and 596,000 in developing countries, which can reduce maternal mortality by adopting appropriate measures in the course of pregnancy and childbirth. (Performance report and achievements of the country’s system of Maternal Death Care, 2010: 2)
Causes of Females Death
The hygienic causes of female deaths include infection, bleeding, failure, high blood pressure, long and difficult labor, complications of unsafe abortion pointed out. At present, 200 million women in the world have unmet needs in the field of contraception. Married women in sub-Saharan Africa, Center and south Asia, more than half of 58% of women have form an unmet need. The most important causes are: Inadequate knowledge about contraceptive methods, Fear of social acceptability, Concerned about side effects and wife’s opposition. These women are at increased risk for unwanted pregnancy, illness abortion, illness and maternal death. (United Nations Population Fund, 2009: 3)
The shortage of health care providers in 38 countries is another factor has been the slowdown in the deaths of mothers. Some countries need to increase the number of midwives more than 10 times. In the world, between 2000 and 2008, 63 percent of childbirth were delivered by professional staff (World Health Organization, 2004)
Therefore, it is necessary to use three global strategies to improve maternal health and reproductive health:
A/ Access to counseling, family planning services and facilities.
B/ Access to quality care during pregnancy and the attendance of trained at childbirth and equipping centers with emergency facilities for obstetrics and childbirth.
C/ Access to abortion services if it is legal
Marl Paul Kulayni ; Deputy Director General for Health and Innovation of the World Health Organization said: “Many women and children lose their lives due to preventable factors, which is linked to inadequate quality of care.”
The four steps that must be carefully considered to reduce maternal and neonatal mortality include:
– When the mother is acceptance in the hospital.
– Before entering the operating room.
– An hour after childbirth
– and before discharge the mother and baby from the hospital.
In fact, these four times allow the physician to control the status of the mother and the child.
The consequences of mother’s death
A baby that survives after the mother’s death rarely will survive until one year of age. The probability of death of children under the age of ten, especially girls, even increases up to four times. Motherless children are also often badly treated and not adequately to be taken care. Older children dropped out of school, girls have to keep the rest of their family members. In many societies, the death of a mother for child girls are an irreparable disaster. Because the mother is the pillar of the family, for this reason, with her death, in some way, the family will collapse and that order and peace will not exist anymore. For this reason, mother’s death is not a cross-sectional event, but its consequences always show itself.
Factors reducing maternal mortality
Mother’s death is not only the destruction of a person, it means destroying the infrastructure of society which is founded by the education of the mother. Maternal mortality is considered to be unacceptable mortality, because many of the causes of these deaths mentioned are preventable and in today’s world there are the necessary facilities for preventing them and having a safe pregnancy and childbirth.
Considering the following can lead to a decrease in maternal mortality rates in the country: 1/ Control of the urinary output of all mothers after normal delivery and cesarean delivery: To reduce diagnostic errors and prevent the deterioration of the patient’s condition in conditions such as postpartum hemorrhage and preeclampsia and preventing to create uncontrollable situations such as disturbed intravascular coagulation disorder, it is necessary to measure the volume of urine output. The request for control of urinary output should be written by specialists in order after childbirth and cesarean section and if there is a urinary output less than 50 ml per hour immediate action should be taken. (Strategies for improving health and reducing maternal mortality, 2016: 3)
2/ Increase awareness of the family about the pregnancy and childbirth complications and ways of dealing with it: It is necessary for all women of reproductive age, especially prior to pregnancy counseling be done before pregnancy.
Women with underlying illness before proceeding with the pregnancy reviewed about changing the dose of drugs and controlling the underlying disease and after the doctor’s permission take action on pregnancy
3/ Attention to equipping and providing hospitals with medicine and the essential requirements that are necessary for the provision of urgent obstetrical and childbirth urgency.
4/ Increased coverage of pregnancy and postpartum care.
5/ Timely identification and prevention of delays in decision making and referral of high-risk cases.
6/ lack of delay in presentation of health care to mothers in hospitals and childbirth centers.
7/ Avoid unnecessary cesarean. (Report on the Performance and Achievements of the Maternity Death Care System, 2010: 3)
8/ The process of identification of high risk mothers will be fully established at the University of Medical Sciences: care units to be created for special groups, including immigrants, drug addicts and the suburbanite people suffer from severe economic poverty, determined doctors are defined for each university.
The process of sending and referring the patient specified and how it is implemented to be evaluated, the leveling of services and the process of sending and referring patients to be designed. Each hospital has a delivery block, defined standards be run for personnel, space, equipment.
9/ review of all mothers of repeated cesarean section in terms of adhesion of the pair: Caesarean section is associated with an increased risk of adhesion of the placenta in subsequent pregnancies, Therefore, it is essential in order for the early diagnosis of the effect of adhesion of the pairs do usual Sonography with the aim of emphasizing the review of coupling adhesion is requested for all mothers of repeated cesarean in case of doubt, confirm with doppler sonography. Mothers with this condition as soon as they are diagnosed, they should be introduced to third-level centers and be taken care of.
10/ Accurate reporting of death cases and the regular formation committee to investigate maternal death: Cases of maternal deaths due to pregnancy and follow up completely its complications and collegiate committees be held in first opportunity.
Causes of every death separately and radical with methodology was analyzed by the members of the mother death committee at the hospital and university level. Appropriate interventions based on the causes of death by members of the committee at the hospital and university level should be designed and implemented. (Strategies for improving health and reducing maternal mortality, 2016: 3)
Therefore, services provided to the community and in particular to mothers should have the following features:
Lack of observe for human rights regarding women has led to large inequalities in the deaths of mothers within and between countries. Despite the commitments and efforts of the international community, multiple problems of developing countries, problems such as natural disasters and the problems resulting from it, Limitation of health budget, insufficiency of the health services system, Tuberculosis, AIDS, parasitic infections such as malaria, and ultimately, gender discrimination that prevents women’s health from being a priority, is the possible cause of decrease the rate of maternal mortality. The fifth Millennium Development Goal, which is only be achieved if women’s human rights are at the center of the global equation.
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