Preventable maternal deaths: Ugandan court decisions

Many thanks to Godfrey Kangaude, LL.M. (UFS), LL.M. (UCLA), an LL.D. candidate with the University of Pretoria and Executive Director of Nyale Institute for Sexual and Reproductive Health Governance in Malawi, for composing or editing dozens of analytical summaries of African court decisions for our forthcoming volume, Legal Grounds III: Reproductive and Sexual Rights in Sub-Saharan African Courts.  Previous volumes in the series, published in 2005 and 2010 by the Center for Reproductive Rights, are freely available in print or electronic form.  Legal Grounds online.

Several of the cases involve preventable maternal deaths. Traditionally, families and communities suffer these losses silently, unless a legal advocacy organization brings the case forward.  In Uganda, for instance, the Center for Health, Human Rights and Development (CEHURD) and others brought two maternal death cases to the Constitutional Court of Uganda as human rights violations, but the petition was dismissed without consideration in 2012 as a “political” matter.[1]  In November 2015, however, Uganda’s Supreme Court ordered Constitutional Court to hear the petition on maternal health rights violations.[2]  We still await the Constitutional Court’s  ruling on the merits of CEHURD’s petition.

Just six months earlier, a Ugandan High Court  found human rights violations and awarded damages to the family of a woman who died in obstructed labour at Nakaseke District Hospital; the only doctor who could handle this complication was on duty but could not be found.[3]  As Godfrey Kangaude  comments, “the judgment is an important signal that preventable death of women during pregnancy, labour, and childbirth is a human rights issue.”

Moreover, as Kangaude explains, “Uganda is a party to the International Covenant on the Elimination of All Forms of Discrimination against Women (CEDAW). One of the important decisions on the subject matter under CEDAW is Alyne da Silva Pimentel Teixeira v Brazil (Communication No. 17/2008 CEDAW/C/49/D/17/2008). The Committee on CEDAW (CEDAW Committee) considered the case of a woman who had died of complications of pregnancy as a result of delays in being provided with appropriate care by the health system.[4] The CEDAW Committee found violation of state obligations under Article 12 on the equal right to health, and under Article 2(c) in relation to access to justice, amongst others. It made several recommendations to address the systemic factors, which would apply to the Uganda context . . .” [5]

The CEDAW Committee recommended that the state:

“(a) Ensure women’s right to safe motherhood and affordable access for all women to adequate emergency obstetric care, in accordance with General Recommendation No. 24 (1999) on women and health;

(b) Provide adequate professional training for health workers, especially on women’s reproductive health rights, including quality medical treatment during pregnancy and delivery, as well as timely emergency obstetric care;

(c) Ensure access to effective remedies in cases where women’s reproductive health rights have been violated and provide training for the judiciary and for law enforcement personnel;

(d) Ensure that private health-care facilities comply with relevant national and international standards on reproductive health care; [and]

(e) Ensure that adequate sanctions are imposed on health professionals who violate women’s reproductive health rights.”[6]
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REFERENCES:

[1] Center for Health Human Rights and Development (CEHURD) and 3 Others v Attorney General [2012], Constitutional Petition No. 16 of 2011 (Constitutional Court of Uganda at Kampala). Decision online. Preventable maternal deaths were dismissed as a “political” matter.  Case Summary and Analysis by Nthabiseng Lelisa and Godfrey Kangaude, with special thanks to Nthabiseng Lelisa, an LL.M. candidate in Sexual and Reproductive Rights in the Centre for Human Rights, Faculty of Law, University of Pretoria, South Africa.

[2]  Center for Health, Human Rights and Development & 3 Others  v Attorney General.  [2015], Constitutional Appeal No. 01 of 2013 (Supreme Court of Uganda at Kampala) [Uganda Supreme Court orders Constitutional Court to hear a petition on maternal health rights violations.]  Decision online.  Case summary and analysis by Godfrey Kangaude. 

[3] Center for Health, Human Rights and Development & 4 Others  v Nakaseke District Local Administration [2015], Civil Suit No. 111 of 2012 (High Court of Uganda at Kampala). [Ugandan High Court finds human rights violations where a pregnant woman died of a ruptured uterus and blood loss while in labour.] Decision online. Case summary and Analysis by Godfrey Kangaude 

[4] See also: Rebecca J. Cook “Human Rights and Maternal Health: Exploring the Effectiveness of the Alyne Decision”  41.1 (Spring 2013) Journal of Law, Medicine and Ethics 103-123,  Original publication in EnglishRepublished in SpanishTranslation to PortugueseRepublication in Portuguese journal.

[5] CEHURD v Nakaseke (note 3 above), Case summary and Analysis by Godfrey Kangaude , page 3.

[6] Committee on the Elimination of Discrimination against Women,  Alyne da Silva Pimentel Teixeira (deceased) v Brazil, Communication No.17/2008, CEDAW/C/49/D/17/2008), Recommendations, 8.2.  CEDAW decision Sept 27, 2011


Legal Grounds: Reproductive and Sexual Rights in African Commonwealth Courts   (up to 2008) Volumes I and II can be downloaded here.  Our update will be published early in 2017.  Decisions already identified for Volume III  are online here.  New case summaries are added every month.   If you can suggest other cases, please do!   How You Can Help.

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