President Zuma’s commitments set a new ideological standard in South Africa that breaks from previous conceptions of the disease. Former President Thabo Mbeki received widespread criticism for his ideas about the nature and treatment of the epidemic. He is often noted as a denialist of the viral cause of AIDS and the effectiveness of antiretroviral treatment. A Harvard University study reported in The New York Times found that more than 330,000 premature deaths could have been prevented if Mbeki’s administration had backed the provision of antiretroviral drugs to AIDS patients.

Despite Mbeki’s misguided stance, that Jacob Zuma reversed his predecessor’s rhetoric on HIV/AIDS came as somewhat of a surprise. A husband to three wives – an acceptable facet of his Zulu heritage but a risk factor for contracting HIV – and the defendant in a 2006 criminal case for the rape of an HIV-positive friend, he is an improbable leader in the AIDS movement.

But the public announcement of his policy overhaul stands to salvage his reputation and, of course, countless lives. South Africa has the highest prevalence of HIV in the world: UNAIDS/WHO estimate that 5.7 million are infected with HIV, including 3.2 million women and 280,000 children aged 0–14. Zuma’s particular focus on women and children heralds a concrete and strategic approach to curbing the spread of HIV/AIDS. He said that the policy changes to take effect next April would include treatment for all children under one year old who test positive for HIV, with no regard for their CD4 count. Treatment is expanding for other high-risk groups, such as people with tuberculosis and HIV, as well as pregnant women who are HIV positive. Counseling, testing, and treatment would all be part of the care package.

UNAIDS executive director Michel Sidibé spoke at the event before President Zuma took the stage. In his speech he correlated health and human rights, emphasizing in particular the position of women and children. He remarked, “AIDS reveals many fundamental injustices. While mother-to-child transmission is now part of the history books in the North, 390,000 African babies were born infected in 2008. Only half of pregnant women living with HIV in South Africa received treatment to prevent transmission of the virus to their child, even though evidence shows that with full access, we can virtually eliminate HIV infection in newborn babies.”

President Zuma hopes to cut infections in half and provide treatment to at least 80% of HIV/AIDS patients by 2011. It’s a tall order but not insurmountable, especially with aid from countries like the United States, which will give South Africa an additional $120 million over the next two years for AIDS treatments. Zuma’s policy reforms are a milestone in South Africa’s battle with HIV/AIDS, but his ultimate success lies in their translation into practice and implementation. Only then can a more ambitious goal be sought: universal access to treatment.

A recent resolution by the United Nations Human Rights Council, adopted in June 2009, “Preventable mortality and morbidity and human rights,” reaffirms and requests new efforts to curb maternal deaths and to promote gender quality and universal access to reproductive health services. Resolution 11/8 tasks the Office of the United Nations High Commissioner for Human Rights (OHCHR) with preparing a “thematic study on preventable maternal mortality and morbidity and human rights, in consultation with States, the World Health Organization, the United Nations Population Fund, the United Nations Children’s Fund and the World Bank, and all other relevant stakeholders.” The study signifies a tangible and actionable way forward for the maternal health agenda.

In order to develop the strongest possible study, the OHCHR has called for input from interested organizations and advocates, due by December 1, 2009. Information is welcome on the following:

(a)    Identification of the human rights dimensions of preventable maternal mortality and morbidity in the existing international legal framework;

 

(b)   An overview of the initiatives and activities within the United Nations system to address all causes of preventable maternal mortality and morbidity;

 

(c)    Identification of how the Council can add value to existing initiatives through a human rights analysis, including efforts to achieve the Millennium Development Goals on improving maternal health; and

 

(d)   Recommended options for better addressing the human rights dimension of preventable maternal mortality and morbidity throughout the United Nations system.

The Center for Reproductive Rights, Action Canada for Population and Development, and the Sexual Rights Initiative suggest that organizations interested in submitting should focus on hard-to-find resources at the intersection of MMM. Here are some examples:

1. Identify how to incorporate a human rights-based approach in addressing this issue. Respondents may provide comments and guidance as to how governments, in both donor and developing countries, can incorporate a human rights-centered approach into their programs and policies to combat maternal injuries and deaths. Input could also include some examples of best practices in incorporating a human rights-based approach to this issue. The Center notes, “We would suggest that, whether the input explores this issue generally or through a best practice case study, the input draw reference to at least some of the basic principles of a human rights-based approach, including: non-discrimination and equality, transparency and participation, monitoring and accountability, and international cooperation and assistance.”

 

2. Identify and describe one or more international initiatives related to MMM or “maternal health.” These might include those that are inter-governmental, based in international organizations, non-governmental, funder-initiated, or mixed. Descriptions should identify whether the initiatives use a human rights framework as a main component to their work, and if so what this framework consists of.

 

3. Identify what gaps exist in the international response to MMM. What is missing in the approach to MMM eradication internationally that the situation has not changed much in the last many years? Such an identification of the gaps is very important in order to determine the role that the Human Rights Council can play in combating maternal mortality and morbidity, to complement and not duplicate existing efforts. Of note, “Inputs in this respect could usefully be holistic in scope or, instead, could seek to identify gaps or limitations relating to one or more particular international initiatives on MMM (which could be inter-governmental, based in international organizations, non-governmental, funder-initiated or mixed). In both cases, the most helpful inputs would seek to identify gaps or limitations that are particularly related to the human rights mandate of the Council (i.e., providing a basis for suggestions that the Council play a role to fill these gaps).”

 

4. Identify concrete steps the Council can take to fill in gaps with respect to the international response to MMM. These need not include only usual recommendations for intergovernmental bodies to address an issue; creative thinking on this point is important and most welcome.

 

5. Identify the actual causes of maternal mortality in countries, whether these are underlying socio-economic or structural causes, barriers in accessing maternal health services, or lack of access to certain types of reproductive health services. It is unlikely that the study will go into particular country situations (except in potential best practice examples), but “such submissions might provide useful support particularly for the identification in the study of root or immediate causes that might have a politically-sensitive nature, such as gender inequality, unsafe abortion, contraception or EC access, and so on.”

If organizations or advocates would like to submit information, please contact the following representatives with information about your organization’s activities in reducing maternal mortality and morbidity: Neha Sood – Youth Coalition (neha at youthcoalition dot org), Ximena Andion – Center for Reproductive Rights (XAndion at reprorights dot org), or Action Canada for Population and Development (sandeep at acpd dot ca).

Resolution 11/8 states that “increased political will and commitment, cooperation and technical assistance at the international and national levels are urgently required to reduce the unacceptably high global rate of preventable maternal mortality and morbidity.” By aligning women’s health and human rights, mobilizing a global network of maternal health advocates and experts, and requesting the implementation of new strategies, the Human Rights Council is on the right track to helping reduce the rate of maternal mortality globally.

If you have relevant and helpful information regarding MMM, you can help, too.