A guest blog by Sarah Rudrum
When I wrote my dissertation about the social organization of maternity care and birth in Amuru, northern Uganda, it began with an account of a legal case spearheaded by The Center for Health, Human Rights and Development (CEHURD). The case alleged that government had violated the human rights of two women who died in childbirth, and acted as a test of the government’s legal obligation to provide care to birthing women. As I wrote then, “The legal struggle drew attention to the dire state of maternity health care in Uganda and attempted to catalyze change in a setting of mounting frustration and anger as maternal deaths continued unabated”.
On May 7, the High Court of Uganda found in favour of the CEHURD and the family of Irene Nanteza who died of preventable causes during childbirth in 2012. Her family will be awarded an approximately $11,000 settlement. CEHURD offered the following account of Nanteza’s death: “Nanteza was taken to Nakaseke hospital by her spouse, Mugerwa David to deliver her baby. While at the hospital, a nurse detected that the deceased suffered an obstructed labour that required urgent intervention by a doctor. The doctor on duty only arrived at the hospital after over eight hours when it was already too late for any medical intervention to reverse the haemorrhage that had arisen due to a ruptured uterus.” Sadly, such deaths due to lack of necessary intervention are not uncommon. The case acts as a call to accountability. As CEHURD’s executive director, Mulumba Moses, stated, the ruling “holds the government accountable for its failure to protect, respect and fulfil human rights as provided for under the 1995 Constitution of the Republic of Uganda and international and regional human rights instruments. A court declaration on emergency obstetric care as a right for women guaranteed in Article 33(3) of the constitution is a step towards the realization of the right to health in Uganda”. More information on the landmark decision can be found at CEHURD
In pursuing strategic litigation as a means of advancing the maternal health agenda, the Ugandan activists are following in the tradition of others, notably in Latin American countries and India. In a piece reviewing strategic litigation in Colombia, Roa and Klugman offer advice to those determining whether such activism is likely to be a successful way forward in their setting. Where initial cases were unsuccessful, they nevertheless built support and paved the way for future successes. This appears also to have been the case in Uganda; Yamin discusses that initial failures in CEHURD’s strategic litigation were nevertheless successes for their ability to impact public opinion on maternal deaths. In Brazil, the Alyne decision (2011) had The Convention for the Elimination of Discrimination Against Women (CEDAW) finding in favour of a woman who died in childbirth; it was significant in that it was the first case of an international human rights board deciding on a maternal death ruling . Kaur’s examination of the 2011 Shanti Devi case in India discusses the limitations of litigation as an approach to ensuring reproductive rights, pointing to both ordinary people’s lack of awareness of their rights, and the lack of institutional accountability. Litigation can also be used to oppose sexual rights, such as in the case of the ‘pro-life’ lobby in Argentina. Strategic litigation has its limits, and legal successes will not lead to overnight transformations of health systems or of women’s access to their sexual and reproductive rights. Nevertheless, for maternal health advocates, the landmark CEHURD decision is cause for celebration.
Lecturer, Institute for Gender, Race, Sexuality and Social Justice, University of British Columbia