Can the right to health inform public health planning in developing countries? A case study for maternal healthcare from Indonesia

Abstract

Background: Maternal mortality remains unacceptably high in developing countries despite international advocacy, health and development targets, and simple, affordable and effective interventions. In recent years, regard for maternal mortality as a human rights issue as well as one that pertains to health, has emerged. Objective: We study a case of maternal death using a theoretical framework derived from the right to health to examine access to and quality of maternal health care. Our objective is to explore the potential of rights-based frameworks to inform public health planning from a human rights perspective. Design: Information was elicited as part of a verbal autopsy survey investigating maternal deaths in rural settings in Indonesia. The deceased’s relatives were interviewed to collect information on medical signs, symptoms and the social, cultural and health systems circumstances surrounding the death. Results: In the case, a prolonged, severe fever and a complicated series of referrals culminated in the death of a 19-year old primagravida at seven months gestation. The cause of death was acute infection. The woman encountered a range of barriers to access; behavioural, socio-cultural, geographic and economic. Several, serious health systems failures were also apparent, reflecting her exclusion from access to healthcare. The theoretical framework derived from the right to health identified that none of the essential elements of the right were upheld. Conclusion: There are fundamental and inherent conflicts between the public health tradition (collective and preventative) and the right to health (individualistic and curative). As a result, and in practice, the right to health is likely to be ineffective for public health planning from a human rights perspective. Collective rights such as the right to development may provide a more suitable means to achieve equity and social justice in health planning.

Keywords: human rights; maternal mortality; developing countries; Indonesia

(Published: 9 September, 2008)

Citation: Global Health Action 2008. DOI: 10.3402/gha.v1i0.1828