Health Rights of Women and Children

Program Goals

HRWC program photo

A photo taken of a woman and child in Ethiopia in connection with HRWC’s study on the impacts of maternal mortality on children.

The Health Rights of Women and Children (HRWC) program, founded and directed by Alicia Ely Yamin, JD, MPH, is informed by the view that the lack of global progress on women’s and children’s health is not principally due to technical obstacles, but rather to entrenched societal barriers and lack of political will at both the national and international levels. Solutions that ignore root causes and underlying inequalities and power relations are not likely to be sustainable. Through targeted advocacy and strategic partnerships, and by acting as a convening platform on key issues, the HRWC program aims to promote equitable and sustained progress on women’s and children’s health and human rights at the international and national levels.

Methods

We seek to advance our work through three sets of related activities:

a)  action-oriented research that provides and evaluates evidence for rights-based policies and interventions related to women’s and children’s health;
b)  international advocacy for human rights standard-setting and the incorporation of human rights principles into global development processes, in particular those concerning women’s and children’s health; and
c)  capacity-strengthening and knowledge dissemination regarding the legal enforcement of health rights, with a particular focus on judgments relating to reproductive, maternal, and children’s health.

Current Projects

1)  Action-Oriented Research

A.  Impacts of Maternal Deaths on Living Children Study

HRWC - Maternal Impacts Study

A photo taken of young girls in Tanzania in connection with HRWC’s study on the impacts of maternal mortality on children.

With support from the Hansen Family Foundation, the HRWC Program is conducting a multi-methods study regarding the impacts of maternal deaths on living children in Tanzania, Ethiopia, Malawi, and South Africa. The study aims to document the cumulative burden of maternal mortality on the family and the community, and to discover the roots of adverse outcomes or resilience in children whose mothers die in pregnancy or childbirth. Data are sparse but highly suggestive of greatly increased morbidity and mortality among the young children left behind when their mother dies. Preliminary evidence suggests increases in family dissolution, malnutrition, and other morbidities as well. By raising awareness of the real costs of failing to meet international development targets around maternal health, the HRWC Program aims to mobilize governments and other key actors to reduce maternal mortality and ameliorate the effects of maternal deaths on children.

Yamin presented preliminary findings from the study at the Global Maternal Health Conference in early 2013. A video of the talk can be viewed here. The findings from the qualitative work in Tanzania detail the profound effects of a maternal death on child health and family well-being and were published in August 2013 in PLOS One, Costs of Inaction on Maternal Mortality: Qualitative Evidence of the Impacts of Maternal Deaths on Living Children in Tanzania.

In November 2013, the project leaders from the Impacts of Maternal Death on Living Children study launched the Frontiers in Global Health Seminar series at the Harvard School of Public Health. The session entitled “The true costs of maternal mortality on children and families: a discussion of findings from Tanzania, Ethiopia, South Africa, and Malawi” can be viewed here.

In collaboration with the Women & Health Initiative (W&HI), a joint dissemination event was held in November in Tanzania to disseminate the W&HI’s research findings on respectful maternity care and FXB’s policy recommendations on mitigating the impacts of maternal death on children, while creating links between those two communities. Approximately 80 stakeholders, ranging from Government officials to NGO representatives to community leaders, attended the event and were overwhelmed learning of the dramatic implications of a maternal death on child survival.

B. Evidence of Impact of Rights-based Approaches to Women’s and Children’s Health

Alicia Ely Yamin was on the Steering Committee and co-authored the “WHO Monograph on Evidence of Impact of Rights-Based Approaches to Women’s and Children’s Health.” The primary research focus of the study was to assess how human rights-based approaches, or elements of such an approach, affect changes that contribute to women’s health and children’s health, arising from laws, policies, programs and other interventions, designed and implemented, either explicitly or implicitly, by a human rights-based approach, or elements of such an approach.In addition to examining existing evidence, the project outlined multi-method, multi-disciplinary approaches to research and evaluation on evidence of impact of a human rights-based approach on women’s and children’s health, as standard public health approaches are inadequate. The study concluded that by applying human rights to women’s and children’s health policies and other interventions, governments not only help to ensure compliance with their binding national and international obligations, but also contribute to health improvements for women and children.

2) Global outreach and advocacy for human rights principles and standards relating to women’s and children’s health

A. International Human Rights Standard-Setting and Operationalization of Rights-Based Approaches to Health (RBAs)

HRWC regularly participates in expert consultations regarding the development of General Comments and other instruments that interpret and set standards in international law, such as the General Comment of the UN Committee on the Rights of the Child on Children’s Right to Health; and the General Comment of the UN Committee for Economic, Social, and Cultural Rights on the Right to Sexual and Reproductive Health.

As part of global outreach, HRWC frequently contributes to knowledge sharing and capacity strengthening relating to rights-based approaches. For example, in 2013, Yamin contributed to the Partnership for Maternal, Newborn & Child Health’s Knowledge Summary on Maternal Health and Human Rights. The Knowledge Summary explores human rights accountability systems and synthesizes evidence on maternal health and human rights into a user-friendly format to inform policy and practice. Yamin further described accountability systems for women’s health to members of treaty-monitoring bodies as part of the “Accountability and Human Rights for Women’s and Children’s Health” meeting of the independent Expert Review Group (iERG) of the WHO in Geneva.

In 2012, Yamin was the lead consultant to draft the Technical Guidance on the Application of a Human Rights-Based Approach to the Implementation of Policies and Programmes to Reduce Preventable Maternal Morbidity and Mortality for the UN Office of the High Commissioner for Human Rights, which is the first such concrete guidance on human rights-based approaches (HRBAs) to be adopted by resolution of the United Nations Human Rights Council and which sets a landmark precedent in terms of operationalizing HRBAs. In 2013, Yamin published two articles describing the role of the Technical Guidance in human rights work:

Yamin, AE. Applying human rights to maternal health: UN Technical Guidance on rights-based approaches. International Journal of Gynecology and Obstetrics. 2013; 121(2): 190-193.

Yamin, AE. From Ideals to Tools: Applying Human Rights to Maternal Health. PLOS Medicine. 2013; 10(11): e1001546. doi: 10.1371/journal.pmed1001546.

Yamin has presented the Technical Guidance in webinars and lectures around the world, including for UNFPA’s global staff and at the Global Maternal Health Conference in early 2013, in a talk entitled, ‘Applying rights-based approaches for the prevention of maternal mortality and morbidity: Recent developments at the United Nations,’ as well as at the American Public Health Association (APHA) in November 2013.

The Technical Guidance was featured at a regional workshop in Malawi in November 2013, jointly organized by the WHO, OHCHR, PMNCH, and UNFPA,  as a step in a multi-part project dedicated to developing the tools to operationalize and evaluate implementation of human rights-based approaches (HRBAs) to health. The objective of the meeting was to train and mobilize in-country health policymakers and representatives of national human rights institutions on HRBAs to maternal and child health, including issues of sexual and reproductive health, providing a range of stakeholders with specific operational tools to implement their obligations. National consultation processes are scheduled to follow on from this regional meeting. HRWC is also engaged in producing implementation tools for various stakeholders with respect to the Technical Guidance.

B. Promoting Development Agendas that Advance the Rights of Women and Children

HRWC regularly participates in expert consultations on the post-Millennium Development Goals (MDG) agenda.  Yamin is frequently called on to contribute op-eds, commentaries and blogs to global opinion-shaping forums, such as the Council on Foreign Relations’ Emerging Voices online series (Emerging Voices: Alicia Ely Yamin on Defining the Next Set of Global Development Goals), Women Deliver (2015+: Reclaiming a seat at the table), the UK Guardian (Family planning: population numbers game must add up for women), and UNICEF’s  Development Research Watch (Post-MDGs: What next for a global development agenda that takes human rights seriously?). Yamin was included as a leading voice in Shaping Our Shared Future Beyond 2015: Perspectives from the Global South. The report brings together views and recommendations on the renewed global development agenda from civil society leaders across the global south. Yamin also contributed an article, “Power and Participation in Moving Toward 2015 and Beyond: A View from Civil Society,” to a special issue of ACRONYM (WFUNA’s journal) focused on perspectives of development beyond 2015, and served as guest editor of a special issue of Health and Human Rights, focused on the Framework Convention on Global Health. Yamin has been elected to the Steering Committee for the Framework Convention on Global Health (FCGH). The committee aims to develop a legally binding global health treaty grounded in the right to health that addresses national and global health inequities. The guiding principles and recommendations of the FCGH would extend beyond universal health coverage to the broader social determinants of health, and would provide an important contribution to the post-2015 framework by establishing specific standards and accountability measures toward the achievement of post-2015 global commitments. FCGH recently launched an inclusive international Platform designed to increase the involvement of a growing cohort of partners and civil society actors. The Platform for a Framework Convention on Global Health: Realizing the Universal Right to Health will provide greater opportunities for stakeholders to participate in the FCGH process. Yamin also serves on the executive committee of Beyond 2015, the largest civil society group working to promote an inclusive, pro-poor agenda post 2015.

In collaboration with the New School for Social Research and the UN Office of the High Commissioner for Human Rights, HRWC is co-organizing a notable project in regard to human rights and the Post 2015 agenda called The Power of Numbers: A Critical Review of MDG Targets for Human Development and Human Rights. The project refocuses the debate on MDGs, which has been centered on if the MDGs are likely to be achieved. Little attention has been paid to understanding global goals as policy instruments. This project investigates the impact of the MDGs on policy, and assesses if the MDGs have shifted policy priorities of national governments, bilateral donors, multilateral agencies, NGOs, and other stakeholders. Based on the premise that in the post-2015 goal setting process it is important to more carefully consider the selection of indicators, and to employ more rigorous criteria than were used in the development of the MDGs, this project entails a goal-by-goal analysis by leading specialists in the relevant fields, of the choices made, the empirical and normative effects, and the range of options possible for a future development agenda.

The first meeting was held October 3, 2012 at the FXB Center. In 2012, the Nordic Journal of Human Rights published Yamin’s analysis of MDG 5, which relates to improvement in maternal health (Counting What We Know; Knowing What We Count: Sexual and Reproductive Rights, Maternal Health, and the Millennium Development Goals). In 2013, Reproductive Health Matters published an analysis of sexual and reproductive health under the MDGs, Embedding Sexual and Reproductive Health and Rights in a Transformational Development Framework: Lessons Learned from the MDG Targets and Indicators, and Development journal published a synthesis of the The Power of Numbers Project, The Power of Numbers: A Critical Review of MDG Targets for Human Development and Human Rights, which analyzed the influence of MDGs on policy priorities and development narratives.

Alicia Yamin, Sakiko Fukuda-Parr, and Gita Sen discuss MDG targets and the road ahead towards defining achievable indicators for the Post-2015 agenda.

Alicia Yamin, Sakiko Fukuda-Parr, and Gita Sen discuss MDG targets and the road ahead towards defining achievable indicators for the Post-2015 agenda.

Power of Numbers co-organizer Sakiko Fukuda-Parr of the New School wrote an op-ed for UNICEF’s Research Watch, summarizing the motivation behind the project. The findings of the project have been presented at meetings in Geneva, hosted by the Friedrich Ebert Stiftung Foundation and UNDP, at the Human Rights Council, at the Rockefeller Foundation, and at the UN General Assembly September 2013 at a side event sponsored by the Dag Hammarskjold Foundation in Sweden and co-sponsored by the Permanent Missions of Colombia and Sweden to the UN.

JacketIn 2013, Yamin also co-edited, with Malcolm Langford and Andy Sumner, The Millennium Development Goals and Human Rights: Past, Present and Future (London: Cambridge University Press). The Millennium Development Goals (MDGs) have generated tremendous discussion in global policy and academic circles. On the one hand, they have been hailed as the most important initiative ever in international development. On the other hand, they have been described as a great betrayal of human rights and universal values that has contributed to a depoliticization of development. With contributions from scholars from the fields of economics, law, politics, medicine, and architecture, this volume sets out to disentangle this debate in both theory and practice. It critically examines the trajectory of the MDGs, the role of human rights in theory and practice, and what criteria might guide the framing of the post-2015 development agenda. The book is essential reading for anyone interested in global agreements on poverty and development.

3) Capacity-Strengthening and Knowledge Dissemination Regarding Legal Enforcement of Health Rights

A. Global School on Socioeconomic Rights: Course on Health Rights Litigation

Participants during a session of the 2013 Global School.

Participants during a session of the 2013 Global School.

The last fifteen years have seen a tremendous growth in the number of health rights cases. Yet questions still persist as to when and how litigation can lead to greater social justice in health and enhance the functioning of health systems, rather than distorting priorities. Furthermore, in many countries people view litigation as an expensive, technical, and difficult process. The resulting lack of legal challenges weakens the enforcement of health-related laws, leaving people unable to promote their own health rights and manage their own health risks. It also allows for gross inequities in the distribution of resources for health, including a lack of attention to vulnerable groups. To address these ongoing challenges, the HRWC Program, in conjunction with the Global School on Socioeconomic Rights, leads a one-week intensive training course for academics, students, and practitioners in strategic litigation relating to health rights, in particular those of women and children.

In September 2013 HRWC hosted participants from 24 countries for the health rights litigation course’s second year. Participants raved about the course stating:

“It has been an amazing experience, and the network and learning we gained is invaluable. Thank god for this opportunity and hopefully you will hear a lot about the judiciability of ESCR in the future.” – Participant, Central America

“This is a great course, and is quite high level, with diverse perspectives highlighted. It is an interesting blend of academics and practitioners.” – Participant, North America

“It is an amazing and unique opportunity to learn from different standpoints about the judiciability of the right to health.” – Participant, South America

“I like that this course goes beyond the nice language of conventions to the realities of resources as well as practical issues like how to frame arguments.” –  Participant, Africa

“I thoroughly enjoyed the course and the events planned.” – Participant, Africa

In conjunction with the 2013 course, the FXB Center’s Health and Human Rights Journal will release a special issue on health rights litigation, guest edited by Yamin.

In 2014, the Global School course will focus exclusively on sexual and reproductive rights (SRR) litigation, including such topics as: abortion, criminalization of sex work, litigating LGBT rights in varied contexts, access to sexual and reproductive health entitlements, and working with marginalized groups in doing SRR advocacy. The three-day intensive course, held November 3-5, 2014 at Harvard University in Boston, MA, will enable participants to develop specialist-level knowledge in relation to litigating on sexual and reproductive health and rights at national and international levels, as well as afford ample opportunities for engaging in discussions and network building with practitioners from across the globe. Instructors include leading practitioners and judges from around the world, as well as scholars from the field.

Participants in the Harvard SRR litigation course this year will also be invited to attend a two-day international symposium on “Sexual and Reproductive Rights ‘Lawfare’ in International Tribunals” which will be held at Harvard University on November 6-7, and will draw leading experts from around the world to discuss the dynamics as well as the normative and empirical impacts of using international tribunals and forums in relation to controversial SRR issues.

The course is conducted in English, is highly participatory, and uses case studies extensively. Last year’s course included participants from twenty-four different countries worldwide. The course is designed for PhD students, scholars, practitioners (e.g., law, public health, human rights or development), policy-makers and advanced master’s students. The number of participants is restricted, and fellowships are limited. Applications are due to rcantor@hsph.harvard.edu by July 1, 2014.

Read more about the Global School on Socioeconomic Rights: 2014 Course on Sexual and Reproductive Health and Rights Litigation and access the application.

B. Health Rights Litigation Workshops and Strategic Advisory Role

In addition to the annual health rights litigation course, HRWC regularly advises public interest lawyers and NGOs on strategic litigation relating to health rights, and participates in regional workshops on health rights litigation. For example, in collaboration with the Center for Health Human Rights & Development (CEHURD) in Uganda, HRWC co-sponsored a regional East African workshop on health rights litigation in Kampala, Uganda in 2012 and in December 2013, HRWC and CEHURD co-organized a regional workshop in Uganda on Access to Patient and Other Health-Related Information. The workshop established a network of groups working on health rights litigation in East Africa, aided in the development of strategies for overcoming barriers to access to information in specific cases and facilitated capacity strengthening.

Yamin is globally recognized as a leader in this field and regularly lectures at institutions such as the World Bank and World Health Organization in relation to legal enforcement of health rights. Yamin’s work has been cited by courts from Colombia to India in judgments enforcing health rights, and in 2011, Yamin was named by the Colombian Constitutional Court as an independent expert on the implementation of T 760/08, a major judgment that restructured the health system. In 2014, Yamin was elected to be on the Steering Committee for the World Bank Institute program, 4th Latin American Regional Symposium on the Right to Health and Health Systems ["4o. Encuentro Latinoamericano sobre Derecho a la Salud y Systemas de Salud"].

Selected Publications

Yamin, AE and Norheim, OF. Taking equality seriously: Applying human rights frameworks to priority setting in health. Human Rights Quarterly. 2014; 36:296-324.

Fukuda-Parr, S, Yamin, AE, Greenstein, J. The Power of Numbers: A Critical Review of MDG Targets for Human Development and Human Rights. Journal of Human Development and Capabilities. 2014; doi: 10.1080/19452829.2013.864622

Yamin, AE and Boulanger, VM. Why Global Goals Matter: The Experience of Sexual and Reproductive Health and Rights in the MDGs. Journal of Human Development and Capabilities. 2014; doi: 10.1080/19452829.2014.896322

Yamin, AE and Boulanger, VM. Embedding sexual and reproductive health and rights in a transformational development framework: lessons learned from the MDG targets and indicators. Reproductive Health Matters. 2013; 21(42): 74-85. Access full issue.

Yamin, AE. From Ideals to Tools: Applying Human Rights to Maternal Health. PLOS Medicine. 2013; 10(11): e1001546. doi: 10.1371/journal.pmed1001546.

Yamin, AE, Boulanger, VM, Falb, KL, Shuma, J, Leaning, J. Costs of Inaction on Maternal Mortality: Qualitative Evidence of the Impacts of Maternal Deaths on Living Children in Tanzania. PLoS ONE. 2013; 8(8): e71674. doi:10.1371/journal.pone.0071674.

Fukuda-Parr, S and Yamin, AE. The Power of Numbers: A Critical Review of MDG Targets for Human Development and Human Rights. Development. 2013; 56 (1): doi:10.1057/dev.2013.8.

Yamin, AE. Applying human rights to maternal health: UN Technical Guidance on rights-based approaches. International Journal of Gynecology and Obstetrics. 2013; 121(2): 190-193.

Yamin, AE and Falb, KL. Counting What We Know: Knowing what to Count: Sexual and reproductive rights, maternal health, and the Millennium Development Goals. Nordic Journal on Human Rights. 2012; 30:3: 350–371.

Yamin, AE. Toward Transformative Accountability: A Proposal for Rights-based Approaches to Fulfilling Maternal Health Obligations. Sur: An International Journal. 2010; 7(12): 95-122. [Also reprinted in: Hunt P, Gray T (eds). Maternal Mortality, Human Rights and Accountability. Oxford: Routledge; 2013, 129-143.]

See the full list of Yamin’s publications.

HRWC Collaborators

See the full list of FXB partners.

Addis Adaba University, Ethiopia
Center for Health Human Rights & Development (CEHURD)
Center for Reproductive Rights
Christian Michelsen Institute
Global School on Socioeconomic Rights
Harvard Center for Population and Development Studies
Human Sciences Research Council, Durban
KELIN Kenya
New School Graduate Program in International Affairs
Norwegian Centre for Human Rights
Partners in Health – Malawi Country Team
UN Office of the High Commissioner for Human Rights