Duty to prevent discrimination by private health providers on grounds of gender, race or economic status in Brazil
The communication represented the first instance of maternal mortality to be addressed by the international system of human rights, and examined accountability of health provision, in relation to compounding forms of discrimination. The victim was a poor woman of Afro-Brazilian ethnicity. The ethnic, socio-economic and gender factors were widely recognized to be a factor in disparate health services, however, the case illustrated well the breadth and depth of structural factors.
At 28 years old, Alyne died after giving birth to a still-born fetus due to the failure to receive basic obstetric care, including adequate tests, more appropriately paced medical responses, the necessary equipment, and poor handling of a transfer to a specialized health facility. Also citing issues of funding health care systems and the State’s responsibility for progressive realization, these shortcomings were found to be a violation of Articles 2(e), 2(c) and 12 of the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) concerning access to justice, due diligence and access to health, respectively.
The Committee’s conclusions are considered to have contributed greatly to the development of the right to health with respect to women due to their cross-reference to Article 12 of the International Covenant on Economic, Social and Cultural Rights and the corresponding General Comment No. 14. This reasoning strengthened the understanding of the rights contained in both instruments, while the examination of factors of race and poverty expanded the scope of considerations to be made with regards to discrimination in social protection for women. It was also confirmed that the state “always maintains the duty to regulate and monitor private health-care institutions” (para. 7.5) and has direct responsibility for the services, regardless of whether the institution is public or private.
Case Title: Alyne da Silva Pimentel vs. Brazil
Date of Views: 27 September 2011 [Link to official record]