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http://www.theguardian.com/global-development/poverty-matters/2014/apr/01/reproductive-rights-wrongs-discrimination-maternity-care

BRAZIL – DEATH OF AFRO-BRAZILIAN WOMAN & THEN PAYOUT, HIGHLIGHT DISCRIMINATION IN MATERNITY CARE

An expectant mother is assessed by a Cuban doctor in Brazil, the first country to pay compensation for inadequate maternity care. Photograph: Ueslei Marcelino/Reuters

1 April 2014 - Last week, Brazil become the first country to pay compensation to the family of a woman who died in childbirth as a result of negligence and discriminatory practices in maternity care.

This is a milestone in the battle to establish accessible and affordable reproductive healthcare as a human right. But while Brazil's move is a significant one, celebrations remain muted. It has taken the government too long to get this far.

Some 11 years ago, Alyne da Silva Pimentel, a poor Afro-Brazilian, 26, was six months into her second pregnancy. She sought help from a local health centre after the onset of nausea and abdominal pain. The signs that Da Silva's pregnancy was high-risk were plentiful and clear; nevertheless, she was given pain medication and sent home.

Da Silva's condition quickly deteriorated. When she returned to the health centre the doctors discovered she had miscarried. The foetus was removed, but her condition worsened. Yet it took more than eight hours to get an ambulance to take her to a maternity hospital.

Once there, it took a further 21 hours for Da Silva to receive medical treatment. By then it was too late; she had slipped into a coma. Da Silva died on 16 November 2002 – five days after first seeking professional help.

It took another nine years and a historic decision from the UN committee on the elimination of discrimination against women to get Brazil to admit its failures in the case.

In the first maternal death case brought before it, the committee ruled that the failure of Brazil's public health system to provide timely care to Da Silva amounted to discrimination and a violation of her human rights. The government was ordered to pay compensation to Da Silva's mother, as well as the child she left behind, and to bolster its public health system to prevent other women from suffering a similiar fate.

Brazil has only just begun to honour its obligations to Da Silva's mother. The payout to Da Silva's daughter has been held up in court because the state has appealed against the decision.

More than 4,000 Brazilian women die each year from complications with their pregnancy. Maternal mortality remains the leading cause of death among women of childbearing age, with poor Afro-Brazilians disproportionately affected.

Brazil's maternal health crisis is mirrored in other parts of the world. Every day, 800 women around the globe die from pregnancy complications; many more suffer indignities, injuries and rights violations.

In Kenya, expectant mothers have been denied medical attention, treated cruelly by staff, and even held hostage in maternity wards if they are unable to pay their hospital bills.

In Oaxaca state in Mexico, there are reports of indigenous women giving births in yards, waiting rooms and even on the steps outside state clinics.

The courts are finally taking heed of such injustices and handing down rulings that press governments to provide adequate maternity care, irrespective of race, ethnicity or economic status.

But justice delayed is justice denied for the many thousands of women who suffer and die needlessly in the years it takes to secure these rulings and get them implemented. And so our celebration of maternal reparations in Brazil is accompanied by a renewed call for action to governments around the world to halt the preventable deaths of expectant mothers.

Until more meaningful action is taken to address the systemic inequalities that are allowed to fester in maternity care, the tragedy that led to this landmark victory will be repeated in Brazil and beyond.

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