National College Mihai Viteazul

Human Rights The Right To Special Care And Assistance For Mothers And Children

Coordonating teacher: Anca Negulescu Wright

Student:Petcu Beatris Alexandra

Contents:

Preface

I. Mothers and children matter-so does their health 5

1. Mothers and children matter-so does their health 6

2.The Early years of maternal and child health 8

3.Where we are now???:box1.1,box1.2 13

4.Uneven gains in child health 14

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5.Few signs of improvement:box 1.3 15

II.A continuum care to save newborn lives 16

1.Three Brazilian birth cohorts 19

2.Children’s Rights in Turkey 20

III.Mother’s rights

1.Single mother assistance 23

2.Mothers know your rights!!!! 24

CODE OF GOOD PRACTCE ON PREGNANCY AND AFTER BIRTH 25

“You don't really understand human nature unless you know why a child on a merry-go-round will wave at his parents every time around - and why his parents will always wave back.”

~William D. Tammeus

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The right to special care and assistance for mothers and children is a right that involves you as a person, as an individual, you as a child and future mother. The reason why I have chosen to talk about this right is because in my opinion being a mother is the most difficult “job” a person can have and mothers should have at least the right to special care and assistance for her and for her child. Over the centuries woman’s rights have been ignored and restricted to a life of “housekeeping”. As a woman you would have to be a slave in your own body and as a mother your rights would have been limited to give birth and to raise the child until he has the perfect age for his father to take control over him. The rights of a mother were so deeply buried that if women didn’t gave birth to a boy, an heir, she was rejected by her husband and even punished. I think that it is time for us to take the mater more serious because all woman face the same problem when they are children and when they are mothers : their rights. Even if you are a teacher ,even if you have your own child or even if you adopt one you are still a mother , the most important person in the world ,the one who gives birth to a new world ,the one who is there for you no mater what time ,what place or reason ,the one who illuminates you ,the one you will appreciate later on as the most incredible “creature “you could have ever meet.

A mother is the most important achievement a woman can have and nobody , not even the most brilliant people in the world have been able to describe it.

“To describe my mother would be to write about a hurricane in its perfect power. “ Maya Angelou

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Human Rights

Article 25/(2)

Article 25.

(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

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(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protectio

I. Mothers and children matter -so does their health

The healthy future of society depends on the health of the children of today and their mothers, who are guardians of that future. However, despite much good work over the years, 10.6 million children and 529 000 mothers are still dying each year, mostly from avoidable causes. This chapter assesses the current status of maternal and child health programmes against their historical background. It then goes on to examine in more detail the patchwork of progress, stagnation and reversals in the health of mothers and children worldwide and draws attention to the previously underestimated burden of newborn mortality. Most pregnant women hope to give birth safely to a baby that is alive and well and to see it grow up in good health. Their chances of doing so are better in 2005 than ever before – not least because they are becoming aware of their rights. With today’s knowledge and technology, the vast majority of the problems that threaten the world’s mothers and children can be prevented or treated. Most of the millions of untimely deaths that occur are avoidable, as is much of the suffering

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that comes with ill-health. A mother’s death is a tragedy unlike others, because of the deeply held feeling that no one should die in the course of the normal process of reproduction and because of the devastating effects on her family (1). In all cultures, families and communities acknowledge the need to care for mothers and children and try to do so to the best of their ability. An increasing number of countries have succeeded in improving the health and well-being of mothers, babies and children in recent years, with noticeable results. However, the countries with the highest burden of mortality and ill-health to start with made little progress during the 1990s. In some, the situation has actually worsened in recent years. Progress has therefore been patchy and unless it is accelerated significantly, there is little hope of reducing maternal mortality by three quarters and child mortality by two thirds by the target date of 2015 – the targets set by the Millennium Declaration (2, 3).In too many countries the health of mothers and children is not making the progress it should. The reasons for this are complex and vary from one country to another. They include the familiar, persistent enemies of health – poverty, inequality, war and civil unrest, and the destructive influence of HIV/AIDS – but also the failure to translate life-saving knowledge into effective action and to invest adequately in public health and a safe environment. This leaves many mothers and children, particularly the poorest among them, excluded from access to the affordable, effective and responsive care to which they are entitled. For centuries, care for childbirth and young children was regarded as a domestic affair, the realm of mothers and midwives. In the 20th century, the health of mothers and children was transformed from a purely domestic concern into a public health priority with corresponding responsibilities for the state.

2. THE EARLY YEARS OF MATERNAL AND CHILD HEALTH

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The creation of public health programmes to improve the health of women and children has its origins in Europe at the end of the nineteenth century. With hindsight, the reasons for this concern look cynical: healthy mothers and children were seen by governments at that time to be a resource for economic and political ambitions. Many of Europe’s politicians shared a perception that the ill-health of the nation’s children threatened their cultural and military aspirations. This feeling was particularly strong in France and Britain, which had experienced difficulties in recruiting soldiers, fit enough for war. Governments saw a possible solution in the pioneering French experiments of the 1890s, such as Léon Dufour’s Goutte de lait (drop of milk) clinics and Pierre Budin’s Consultations de nourrissons (infant welfare clinics). These programmes offered a scientific and convincing way to produce healthy children who would become productive workers and robust soldiers. The programmes also increasingly found support in the emerging social reform and charitable movements of the time. As a result, all industrialized countries and their colonies, as well as Thailand and many Latin American countries, had instituted at least an embryonic form of maternal and infant health services by the onset of the 20th century. The First World War accelerated the movement. Josephine Baker, then Chief of the Division of Child Hygiene of New York, summed it up as follows:

One of the first maternal and child health clinics, in the late 19th century, were‘L’OEuvre de la goutte de lait’: Dr Variot’s consultation at the Belleville Dispensary, Paris.

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“It may seem like a cold-blooded thing to say, but someone ought to point out that the World War was a back-handed break for children ... As more and more thousands of men were slaughtered every day, the belligerent nations, on whatever side, began to see that new human lives, which could grow up to replace brutally extinguished adult lives, were extremely valuable national assets. [The children] took the spotlight as the hope of the nation. That is the handsomest way to put it. The ugliest way – and, I suspect, the truer – is to say flatly that it was the military usefulness of human life that wrought the change. When a nation is fighting a war or preparing for another ... it must look to its future supplies of cannon fodder”. Caring for the health of mothers and children soon gained a legitimacy of its own, beyond military and economic calculations. The increasing involvement of a variety of authorities – medical and lay, charitable and governmental – resonated with the rising expectations and political activism of civil society (1). Workers’ movements, women’s groups, charities and professional organizations took up the cause of the health of women and children in many different ways. For example, the International Labour Organization proposed legal standards for the protection of maternity at work in 1919; the New York Times published

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articles on maternal mortality in the early 1930s; and in 1938 the Mothers’ Charter was proclaimed by 60 local associations in the United Kingdom. Backed by large numbers of official reports, maternal and child health became a priority for ministries of health. Maternal and child health programmes became a public health paradigm alongside that of the battle against infectious diseases. These programmes really started to gain ground after the Second World War. Global events precipitated public interest in the roles and responsibilities of governments, and the Universal Declaration of Human Rights in 1948 by the newly formed United Nations secured their obligation to provide “special care and assistance” for mothers and children .This added an international and moral dimension to the issue of the health of mothers and children, representing a huge step forward from the political and economic concerns of 50 years earlier. One of the core functions assigned to the World Health Organization in its Constitution of 1948 was “to promote maternal and child health and welfare” .By the 1950s, national health plans and policy documents from development agencies invariably stressed that mothers and children were vulnerable groups and therefore priority “targets” for public health action. The notion of mothers and children as vulnerable groups was also central to the primary health care movement launched at Alma-Ata (now Almaty, Kazakhstan) in 1978. This first major attempt at massive scaling up of health care coverage in rural areas boosted maternal and child health programmes by its focus on initiatives to increase immunization coverage and to tackle malnutrition, diarrhea and respiratory diseases. In practice, child health programmes were usually the central – often the only – programmatic content of early attempts to implement primary health care.

3. WHERE WE ARE NOW: A MORAL AND

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POLITICAL IMPERATIVE

The early implementation of primary health care often had a narrow focus, but among its merits was the fact that it laid the groundwork for linking health to development and to a wider civil society debate on inequalities. The plight of mothers and children soon came to be seen as much more than a problem of biological vulnerability. The 1987 Call to Action for Safe Motherhood explicitly framed it as “deeply rooted in the adverse social, cultural and economic environments of society, and especially the environment that societies create for women” .Box 1.1 recalls some important milestones in establishing the rights of women and children. In this more politicized view, women’s relative lack of decision-making power and their unequal access to employment, finances, education, basic health care and other resources are considered to be the root causes of their ill-health and that of their children.Poor nutrition in girls, early onset of sexual activity and adolescent pregnancy all have consequences for well-being during and after pregnancy for both mothers and children. Millions of women and their families live in a social environment that works against seeking and enjoying good health. Women often have limited exposure to the education, information and new ideas that could spare them from repeated childbearing and save their lives during childbirth. They may have no say in decisions on whether to use contraception or where to give birth. They may be reluctant to use health services where they feel threatened and humiliated by the staff, or pressured to accept treatments that conflict with their own values and customs (13). Poverty, cultural traditions and legal barriers restrict their access to financial resources, making it even more difficult to seek health care for themselves or for their

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children. The unfairness of this situation has made it obvious that the health of mothers and children is an issue of rights, entitlements and day-to-day struggle to secure these entitlements. The shift to a concern for the rights of women and children was accelerated by the International Conference on Population and Development, held in Cairo, Egypt, in 1994. The conference produced a 20-year plan of action that focused on universal access to reproductive health services (of which maternal and child health care became a subset), which was grounded in individual choices and rights. This change in perspective is important, because it alters the rationale for investing in the health of mothers and children. Today, more is known than ever before about what determines the health of women and children and about which interventions bring about improvements most cost effectively.This knowledge makes investment more successful and withholding care even less acceptable. The health of mothers and children satisfies the classical criteria for setting public health priorities (see Box 1.2). Compelling as these arguments may be, however, they miss two vital points.

BOX 1.1 Over the past two decades United Nations bodies, as well as international, regional and national courts, have increasingly focused on the human rights of mothers and children. The Universal Declaration of Human Rights states that “motherhood and childhood are entitled to special care and assistance”.1948 The General Conference of the International Labour Organization adopts the Maternity Protection Convention.1952

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The Declaration of the Rights of the Child.1959 The International Covenant on Economic, Social and CulturalRights recognizes the right to the highest attainable standard of physical and mental health.1966 The Convention on the Elimination of All Forms of DiscriminationAgainst Women enjoins States parties to ensure appropriate maternal health services.1981 The Convention on the Rights of the Child guarantees children’s right to health. States commit themselves to ensuring appropriate maternal health services.1989 At the United Nations World Summit on Children governments declare their “joint commitment ... to give every child a better future”, and recognize the link between women’s rights and children’s well-being.1990 The United Nations Human Rights Committee expresses concern over high rates of maternal mortality.1993 The United Nations International Conference on Population and Development United Nations Fourth World Conference on Women affirm women’s right of access to appropriate health care services in pregnancy and childbirth. 1995 The United Nations United Nations Human Rights Committee rules that, when abortion gives rise to a criminal penalty even if a woman is pregnant as a result of rape, a woman’s right to be free from inhuman and degrading treatment might be violated. 1996 The United Nations Committee on Economic, Social and Cultural Rights states that measures are required to “improve child and maternal health, sexual and reproductive health services”.2000 The United Nations Committee on the Rights of the Child states that adolescent girls should

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have access to information on the impact of early marriage and early pregnancy and have access to health services sensitive to their needs and rights. 2003 The United Nations Commission on Human Rights, states that sexual and reproductive health are integral elements of the right to health. 2003 The United Nations Committee against Torture calls for an end to the extraction of confessions for prosecution purposes from women seeking emergency medical care as a result of illegal abortion. The United Nations Special Rapporteur on the Right to Health reports that all forms of sexual violence are inconsistent with the right to health. 2004 The United Nations Sub-Commission on the Promotion and Protection of Human Rights adopts a resolution on “harmful traditional practices affecting the health of women and the girl child”. 2004

Child health programmes were central to early attempts to implement primary health care. Here a community nurse in Thailand watches as a mother weighs her baby.

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BOX 1.2 WHY INVEST PUBLIC MONEY IN HEALTH CARE FOR MOTHERS AND CHILDREN? Modern states guarantee health entitlements for mothers, newborns and children that are grounded in human rights conventions. Ensuring them access to care has become a moral and political imperative, which also has a strong rational basis. From a public health point of view an important criterion for priority setting and public funding is that cost-effective intervention packages exist. Such packages are well documented in the case of maternal and child health. But cost-effectiveness is only one of the criteria for public investment. Others commonly used include: the generation of positive externalities; the production of public goods and the rule of rescue; and the potential to increase equity and avoid catastrophic expenditure. Any of these criteria can be a sufficient condition for public investment on its own. When more than one is present, as in maternal and child health interventions, the case for public funding is even stronger. Health care for mothers and children produces obvious positive externalities through vaccination or the treatment of the infectious diseases of childhood, and through the improved child health that follows improvement of maternal health. There has been little systematic research on the human, social and economic capital generated by improving the health of mothers and children, but the negative externalities of ill-health are clear.The health of mothers is a major determinant of that of their children, and thus indirectly affects the formation of human capital. Motherless children die more frequently, are more at risk of becoming malnourished and less likely to enroll at school. The babies of ill or undernourished pregnant women are more likely to have a low birth weight and impaired development. Birth-weight children in turn are at greater risk of dying and of suffering

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from infections and growth retardation, have lower scores on cognitive tests and may be at higher risk of developing chronic diseases in adulthood. Healthy children are at the core of the formation of human capital. Child illnesses and malnutrition reduce cognitive development and intellectual performance, school enrolment and attendance, which impair final educational achievement. Intrauterine growth retardation and malnutrition during early childhood have long-term effects on body size and strength with implications for productivity in adulthood. In addition, with the death or illness of a woman, society loses a member whose labour and activities are essential to the life and cohesion of families and communities. Healthy mothers have more time and are more available for the social interaction and the creation of the bonds that are the prerequisite of social capital. They also play an important social role in caring for those who are ill.The economic costs of poor maternal and child health are high; substantial savings in future expenditure are likely through family planning programmes and interventions that improve maternal and child health in the long term. Consequent gains in human and social capital translate into long-term economic benefits. There is evidence of economic returns on investment in immunization, nutrition programmes , interventions to reduce low birth weight , and integrated health and social development programmes Maternal and child health programmes are also prime candidates for public funding because they produce public goods. Although many Low maternal and child health interventions can be classified as private goods, a comprehensive programme also includes components such as information on contraception, on sexual health and rights, on breastfeeding and child care, that are obvious public goods. Moreover, the rule of rescue, which gives priority to interventions that save lives, applies to many maternal and child health interventions.

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Finally, public funding for maternal and child health care is justified on grounds of equity. Motherhood and childhood are periods of particularly high vulnerability that require “special care and assistance”; they are also periods of high vulnerability because women and children are more likely to be poor. Although systematic documentation showing that they are overrepresented among the poor is scarce, women are more likely to be unemployed, to have lower wages, less access to education and resources and more restricted decision-making power, all of which limit their access to care. Public investment in maternal and child health care is justified in order to correct these inequities. In addition, where women and children represent a large proportion of the poor, subsidizing health services for them can be an effective strategy for income redistribution and poverty alleviation. Ill-health among mothers and children, and particularly the occurrence of major obstetric problems, is largely unpredictable and can lead to catastrophic expenditures that may push households into poverty. The risk of catastrophic expenditures is often a deterrent for the timely uptake of care – a major argument, technically and politically, for public investment. First, children are the future of society, and their mothers are guardians of that future. Mothers are much more than caregivers and homemakers, undervalued as these roles often are. They transmit the cultural history of families and communities along with social norms and traditions. Mothers influence early behaviour and establish lifestyle patterns that not only determine their children’s future development and capacity for health, but shape societies. Because of this, society values the health of its mothers and children for its own sake and not merely as a contribution to the wealth of the nation (48). Second, few consequences of the inequities in society are as damaging as those that affect the health and survival of women and children. For governments that take their function of reducing inequality and redistributing wealth seriously, improving the living

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conditions and providing access to health care for mothers and children are good starting points. Improving their health is at the core of the world’s push to reduce poverty and inequality.

4. UNEVEN GAINS IN CHILD HEALTH

Being healthy means much more than merely surviving. Nevertheless, the mortality rates of children under five years of age provide a good indicator of the progress made or the tragic lack of it. Under-five mortality rates fell worldwide throughout the latter part of the 20th century: from 146 per 1000 in 1970 to 79 per 1000 in 2003. Since 1990, this rate has dropped by about 15%, equating to more than two million lives saved in 2003 alone. Towards the turn of the millennium, however, the overall downward trend was showing signs of slowing. Between 1970 and 1990, the under-five mortality rate dropped by 20% every decade; between 1990 and 2000 it dropped by only 12%. The slowing down of progress started in the 1980s in the WHO African and Western Pacific Regions, and during the 1990s in the Eastern Mediterranean Region. The African Region started out at the highest levels; saw the smallest reductions (around 5% by decade between 1980 and 2000) and the most marked slowing down. In contrast, progress continued or accelerated in the WHO Region of the Americas, and the South-East Asia and European Regions. The result is that the differences between regions are growing. The under-five mortality rate

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is now seven times higher in the African Region than in the European Region; the rate was “only” 4.3 times higher in 1980 and 5.4 times higher in 1990. Child deaths are increasingly concentrated in the African Region (43% of the global total in 2003, up from 30% in 1990). As 28% of child deaths still occur in South-East Asia, two of the six WHO regions – Africa and South-East Asia – account for more than 70% of all child deaths. Looking at it another way, more than 50% of all child deaths are concentrated in just six countries: China, the Democratic Republic of the Congo, Ethiopia, India, Nigeria and Pakistan.

5. FEW SIGNS OF IMPROVEMENT IN MATERNAL HEALTH

Pregnancy and childbirth and their consequences are still the leading causes of death, disease and disability among women of reproductive age in developing countries – more than any other single health problem. Over 300 million women in the developing world currently suffer from short-term or long-term illness brought about by pregnancy and childbirth; 529 000 die each year (including 68 000 as a result of an unsafe abortion), leaving behind children who are more likely to die because they are motherless. There have been few signs of global improvement in this situation. However, during the 1960s

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and 1970s, some countries did reduce their maternal mortality by half over a period of 10 years or less. A few countries such as Bolivia and Egypt have managed this in more recent years. Other countries appear to have suffered reversals. Recent success stories in maternal health are less often heard than those for child health. This is partly because it takes longer to show results, partly because changes in maternal mortality are much more difficult to measure with the sources of information available at present. Today, predictably, most maternal deaths occur in the poorest countries. These deaths are most numerous in Africa and Asia. Less than 1% of deaths occur in high-income countries. Maternal mortality is highest by far in sub-Saharan Africa, where the lifetime risk of maternal death is 1 in 16, compared with 1 in 2800 in rich countries. Information on maternal mortality remains a serious problem. In the late 1970s, less than one developing country in three was able to provide data – and these were usually only partial hospital statistics. The situation has now improved but births and deaths in developing countries are often only registered for small portions of the population except in some Asian and Latin American countries. Cause of death is routinely reported for only 100 countries of the world, covering one third of the world’s population. It is even difficult to obtain reliable survey data that are nationally representative. For 62 developing countries, including most of those with very high levels of mortality, the only existing estimates are based on statistical modeling. These are even more hazardous to interpret than those from surveys or partial death registration. The countries that rely on these modeled estimates represent 27% of the world’s births. Effectively, this leaves no record of the fate of 36 million – about 1 out of 4 – of the women who give birth every year. Gradual improvements in data availability, however, mean that a growing database now exists of maternal mortality by country. Since 1990, a joint working group of WHO, the United Nations Children’s Fund (UNICEF)

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and the United Nations Population Fund (UNFPA) has been regularly assessing and synthesizing the available information . It has not been possible, though, to assess changes over time with any confidence the uncertainty associated with maternal mortality estimates makes it difficult to say whether that mortality has gone up or down, so no global downturn in maternal mortality ratios can yet be asserted. Nevertheless, there is a sense of progress, backed by the tracking of indicators that point to significant increases in the uptake of care during pregnancy and childbirth in all regions except sub-Saharan Africa during the 1990s. The proportion of births assisted by a skilled attendant rose by 24% during the 1990s, caesarean sections tripled and antenatal care use rose by 21%. Since professional care is known to be crucial in averting maternal deaths as well as in improving maternal health, maternal mortality ratios are likely to be declining everywhere except for those countries which started the 1990s at high levels. For these, which are mainly in sub-Saharan Africa, there has been no sign of progress. Box 3. Malawi is one country that experienced a significant reversal in maternal mortality: from 752 maternal deaths per 100 000 live births in 1992 to 1120 in 2000, according to the Malawi Demographic and Health Surveys. According to confidential enquiries into maternal deaths in health facilities in 1989 and 2001, three factors apparently contributed to this increase. First, there was a sharp proportional increase in deaths from AIDS. This is not surprising since Malawi’s national HIV prevalence has now reached 8.4%. Second, fewer mothers gave birth in health facilities: the proportion dropped from 55% to 43% between 2000 and 2001. Third, the quality of care within health facilities deteriorated. Between 1989 and 2001 the proportion of deaths associated with deficient health care increased from 31% to 43%. In 2001 only one mother out of

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four who died in the hospital had received standard care. Wrong diagnosis (11% of deaths), delays in starting treatment (19%), wrong treatment (16%), or lack of blood for transfusion (18%): deficient hospital care was the leading principal avoidable factor in 38% of deaths. The diminishing coverage and the worsening of the quality of care are related to the deteriorating situation of the health workforce (itself not independent from the HIV/AIDS epidemic). In remote areas one midwife often has to run the entire rural health centre and is expected to be available for work day and night, seven days a week. One maternity unit out of 10 is closed for lack of staff. Hospitals also experience severe shortages of midwives, and unskilled cleaners often conduct deliveries. The shortage of staff in maternity units is catastrophic and rapidly getting worse; the chances of Malawi women giving birth in a safe environment diminish accordingly.

II. A continuum of care to save newborn lives

The global community recently declared a commitment to “create an environment—at the national and global levels alike—which is conducive to development and to the elimination of poverty”.1 This declaration led to an agreement on eight goals in key areas of global concern: the Millennium Development Goals. Central among those goals are two that aim to reduce maternal and child mortality, goals 4 and 5. Investment in maternal, newborn, and child health is not only a priority for saving lives, but is also critical to advancing other goals related to human welfare, equity, and poverty reduction. The United Nations has led the global community in articulating a rights-based approach to health,

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giving special attention to mothers and children. The Universal Declaration of Human Rights, ratified in 1948, states that “motherhood and childhood are entitled to special care and assistance”.3 The Convention on the Rights of the Child, ratified in 1989, guarantees children’s right to the highest attainable standard of health.4 Other conventions and international consensus documents focus on redressing the gender-based discrimination that might undermine good health, particularly that of girls and women. Only collective responsibility and close coordination among governments, assistance agencies, and civil society will make achieving these goals possible. The challenge is significant. Each year: more than 60million women without skilled care;5 about 515000 women die from pregnancy-related complications;6 almost 11 million children die before they reach the age of 5 years;7 of children who die under the age of 5, 38% die in the first month of life, the neonatal period, and about three quarters of neonatal deaths occur in the first week after birth;8 and there are about 4 million stillbirths. The socioeconomic consequences of maternal, newborn, and child morbidity and mortality are also significant. Many conditions, such as obstructed labour or preterm birth, can cause severe disabilities for survivors, adding stress to already fragile communities and health systems. A mother’s death or illness can jeopardize an entire family’s well-being; the care required for disabled or sick children burdens families; and the loss of current or future earnings exacerbates the cycle of poverty and poor health for families and societies.10 The burden of maternal, newborn, and child mortality falls disproportionately on the world’s poorest countries and on the poorest populations. Within most low-income countries, child mortality rates, for example, are several times higher in the poorest 20% of the population than the richest and yet access to care, such as skilled attendance, is lowest for those most in need.11 Despite the health burden, availability of cost-effective interventions, and the human rights

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imperative, maternal, newborn, and child health needs have lost out over the past decades. Investment is pitifully low given the size of the problem, available cost-effective interventions, and potential gains. Competition between advocates has weakened their collective voice, splitting support for the maternal and child health agenda. In the struggle for resources, priorities have been determined all too often on political grounds rather than need and potential impact. For example, the package of interventions that would best reduce mortality in women and also in newborn infants—female education, family planning, community-based maternity care, and referral services for women with obstetric complications— has received inadequate resources and attention from global policy-makers and national decision-makers. As a result, as resources are directed elsewhere, millions of women continue to endure the risks of childbearing under appalling conditions and babies continue to die unnecessarily. The interventions most likely to reduce child deaths also do not reach those most in need. During the 1980s, the international community created the impetus for a child survival revolution, triggering progress in reducing child mortality. However, since then, progress has stalled and in some countries even reversed. In 2003, the Bellagio Child Survival group published a series in The Lancet as an urgent call for action, indicating the need for a second revolution in child survival. This series has had far-reaching effects at global and national levels. Until recently, the health of newborn babies was virtually absent from policies, programmes, and research in the developing world, although 4 million newborn babies die each year. This issue of The Lancet sees the publication of the first paper, in a series of four, that places newborn babies and their care firmly in the spotlight, highlighting neonatal deaths and cost-effective interventions appropriate for use, particularly where most newborn infants are born and die—at home.8 This series includes new

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analyses produced through a year of teamwork by a wide group of academics, agencies, and non-governmental organizations. The time has come for these health interventions for newborn babies to be integrated into maternal and child health programmes, which in turn need to be strengthened and expanded. Proven cost-effective interventions, delivered through a continuum-of-care approach, can prevent millions of needless deaths and disabilities. The continuum-of-care approach promotes care for mothers and children from pregnancy to delivery, the immediate postnatal period, and childhood, recognizing that safe childbirth is critical to the health of both the woman and the newborn child and that a healthy start in life is an essential step towards a sound childhood and a productive life. Another related continuum is required to link households to hospitals by improving home-based practices, mobilizing families to seek the care they need, and increasing access to and quality of care at health facilities. For example, India has taken the lead in developing a strategy for Integrated Management of Neonatal and Childhood Illness, which extends the earlier strategy, to reach the newborn child as well as older children, and includes home visits as well as facility-based care. And international organizations have joined forces to create three partnerships for safe motherhood, the health of newborn babies, and child survival. To maximize effectiveness, the partnerships have now formed a consortium and are working towards full integration. First, the partnerships are coordinating their advocacy efforts to promote the continuum of care for maternal, newborn, and child health, and to mobilize the additional resources needed to meet the targets of Millennium Development Goals 4 and 5. Second, they are joining in national-level planning meetings to support countries’ efforts to accelerate high and equitable coverage of evidence-based maternal, newborn, and child health interventions.

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Third, the partnerships are planning a high-level global meeting on World Health Day, in Delhi, with the Government of India. The aim of the meeting is to mobilize national and international commitment to the integrated maternal, newborn, and child health agenda, and facilitate coordinated programming, emphasizing the south Asian and African regions. The meeting is building on the launch of the World Health Report 2005, which focuses on maternal, newborn, and child health. Fourth, they will promote accountability at the international level and are considering the possibility of biannual conferences as a mechanism to track and accelerate progress.

1. Epidemiological transition, medicalisation of childbirth, and neonatal mortality: three Brazilian birth-cohorts

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Over the past two decades, Brazil has seen improvements in women’s nutritional status, education, smoking habits, and antenatal care. Neonatal mortality rates (deaths of Live born infants up to 1 month of age), however, have changed little. In this issue of The Lancet, Fernando Barros and colleagues present fascinating data from three birth cohorts who suggest that falling mortality in term infants (37 weeks’ gestation or more) has been offset by a rise in preterm births and deaths, resulting in little change in neonatal mortality. Brazilian health authorities can claim fairly that more preterm infants survive because of better neonatal care: gestation-specific mortality rates have fallen by 50% since 1982. Nonetheless, many preterm deliveries result from pregnancy interruption, either by caesarean section or induction. Such early delivery is often a direct consequence of inappropriate medicalisation. The road to hell is paved with good intentions, and efforts to improve prenatal care have often had unintended consequences. Diethylstilbestrol was used in millions of pregnancies before its association with vaginal cancer in offspring was noted. Uncontrolled use of oxygen and sulphonamides to treat respiratory distress in premature infants in the 1950s triggered epidemics of retinopathy and kernicterus, respectively. A proportion of the epidemic of sudden infant deaths was attributable to pediatricians encouraging prone sleeping for term infants, drawing incorrectly on their experience of nursing preterm infants in this position to avoid aspiration. Arguably the most pernicious example of medicalisation, however, is the promotion of formula milks. The increased health risks of formula feeding have been well documented in communities where illiteracy, poverty, and lack of a clean supply of water are the norm. Formula-fed infants aged under 2 months are nearly six times more likely to die than breastfed infants,3 but inappropriate promotion by milk companies remains widespread.4

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Two medical interventions that are potentially lifesaving, antenatal ultrasonography and caesarean section, are particularly prone to misuse.

2. Children's Health Rights in Turkey

The right to health is one of the significant examples of social rights and includes the tasks that the state must perform. Citizens should expect positive things from the state. In Turkey, legally each individual who is between 0-18 years of age is a child. This paper introduces some legal rights of children related to medical ethics. Parents of a child who is under age and mentally retarded are responsible for giving the necessary education to him/her (Civil Law clause 264 ).If it is not possible for parents to take the necessary precautions due the mental disorders of their children, parents have the right to want the judge to take necessary precautions and expenses to be paid by the government (Civil law clause 273).If parents neglect their responsibilities seriously, it allows maximum interference with sovereignty of children and in such a case, sovereignty rights of parents may be taken away by the judge (Civil Law clause 274). There are also certain sentences concerning Child Health in Criminal law. From this respect, a parent who leaves an ailing child belonging to him or her is punished (Turkish Criminal Law clause 473). Under the Criminal Law, sexual crimes committed against children are punished more severely, and if these crimes are committed by those who have authority on the children, than those persons are

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punished much more severely (Turkish Criminal Law clause 415 and 417). Child abuse and negligence continues to be one of the most important threats to the healthy and normal development of children all over the world. First of all, negligence, in other words "careless taking care of the children" is a problem or a behavior seen in a family atmosphere. But, this problem grows up gradually in other atmospheres as well. Child abuse is a subject that is evaluated in various disciplines. Medical, legal, psychological and sociological approaches all handle the different dimensions of this subject. Naturally, it is observed that, these approaches, even in the description of the "abuse", are in different dimensions about the subject that includes a lot of perspectives and a lot of variables. How can we describe the behaviours that are directed toward the children and collected under the title of "child abuse" all over the world? The first question that needs to be asked is which behaviours are included under the title of "harassment of children"? "Behaviours that prevent the healthy and normal development of a child can be called as "harassment of children". The answer of the question, "how can they be encountered?" is: "Child and teenager abuse can either be in physiological, mental, sexual, emotional or negligence form. Child abuse is a disease that is related with all parts of the society." Because there were a lot of descriptions about child abuse, the World Health Organization assembled experts of the subject to discuss the matter in 1985 and as a result, the following description was accepted: "The intentional and unintentional behaviours which affect a child's physiological and psycho-social development, towards the children by adults, society and country are called as child abuse. This description also includes actions, which a child doesn't percept and adults don't accept. For behaviour to be a child abusing subject, this behaviour doesn't need to be percepted by a child and adults as child abusing subject. (2)."

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Children and their Health Rights The 25/2nd article of Universal Declaration of Human Rights expresses that "Motherhood and childhood are entitled to special care and assistance" and bases the fundamentals of law studies on mother and child, which develops day by day and in international field and affects the nations. Children's rights are a concept that cares about the special conditions of children who are accepted as the most desperate. All rights, basically, remind some obligations and responsibilities. These are the obligations and responsibilities of adults to children, obligations and responsibilities of powerful people to weak people. A basic responsibility of a country is to protect "rights of living" of its people .providing it depends on protecting the health rights of the people. Health rights are described as the right, which provides protection, and development of an individual's health. Protecting an individual's health, both directly and via the cooperation of private enterprise and local administration, is one of the basic obligations of a country.People are in very different health standards in our world. The most affected people from these different standards are the children. Giving equal opportunity for all people in health is basic element of being human .A child's health right begins with the time that she goes into womb. It's related with the mother health in the first degree during the pregnancy of the mother and suckling period. Then, it continues to be related with society's health in different phases. A proclamation about "the right of the children who are hospitalized" published by the world doctors' Unity Day on 22nd October 1996. Health care of the hospitalized children has very close relationship with the processes that affect recovery of the patient such as medical, social, financial conditions. For that reason, special

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care should be taken in the rights of the hospitalized children. That the evaluating and taking care of the bitterness that the children suffer and insufficiency of the treatment on hospitalized children have been well known. For finding the sources to support these children, it is necessary to emphasize the hospitalized children's rights for doctors and public.  For children these include: The rights of receiving effective treatment and taking advantages of the present attempts in order to be saved form the sufferings. The right of receiving necessary health care convenient to his/her age and sex and illnesses, taking advantage of the treatments convenient to the medical science from the health institutions including private ones. The right to be able to hospitalize on time, to be discharged form the hospital as soon as possible. The right of receiving treatment with love, convenient to his/her honor and privacy. The right to be in the recovery process actively, and to take information from the doctors when it is possible about his illnesses. The right to share the same atmosphere with his age groups and to take the care from the people who got health education for this age group. The right to see his parents and other family members including children, unless doctors prohibit it. The right to suck his/her mother when he/she is in the hospital.

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III. MOTRHER’S RIGHTS 1. Single mother assistance Single mothers are often a very overworked, highly stressed part of our population. They're often used to working long hours, sometimes having to juggle one or two or even three jobs just to make ends meet. The idea of making rent, bill or other payments on time is often the goal rather than the typical practice. Because of this, a home loan for single mother families is, without a doubt, financial treasure chests for these financially needy women. A Home loan for single mothers gives single mothers the financial help they need to move into more suitable housing for raising a child in, move into a better neighborhood, and continue to improve their life and the lives of their children. Any financial relief for these women can improve their lives.

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Because single mothers are in a group of the population that are in great need of support, a home loan for single mothers has been created. These loans are giving single mothers the hope that they can have the home of their dreams. Though a home loan for single mothers may not cover the entire cost for better housing, they are a step in the right direction. Many working people do not have the same privileged option and so the loans are a specially crafted to this population. Though loans are available to the general public, home loans for single mother(s) will include details specific only to single mothers. A home loan for single mothers is more than a special opportunity for single mothers to improve the housing conditions for their families; it is a wonderful opportunity to have a chance to own a substantial piece of equity. Real estate equity is an invaluable piece of property to have ownership of. Especially a house purchased at the right time, when the market is just right, and when profits can be easily measured.

A house’s equity, purchased at the right time, can easily be doubled, tripled and so forth. This potentiality can not only spring a single mother to an even greater positive position in her life, it can help inspire more single mothers to make the move to utilize the home loans available. Better housing is typically found in better neighborhoods, which exposes these women and their children to better atmospheres. A phenomenon that in the end will only produce an all around more positive life-changing experience! With more children growing up in safer, more tranquil neighborhoods the potential for better growth personally, mentally, and spiritually can be ten-fold. Home loans for single mothers are a positive springboard for single mothers, their children, as well as society as a whole!

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2. Mother know your rights!!!!!!!

Parental responsibility for children Those with parental responsibility decide on the important aspects of their children’s lives such as education, where they will live, medical treatment etc. Married parents each have parental responsibility which continues until the child is 18 years old. This is the case even if you separate or divorce. A step parent can acquire parental responsibility if s/he marries the parent. An unmarried mother has sole responsibility for a child unless she makes a formal agreement with the father of the child, or there is a court order in favour of the father (which would be granted if the mother was unable to care for the child). An unmarried father has no automatic parental responsibility for their child. They can only acquire parental responsibility by making a formal agreement with the mother by obtaining a court order, by becoming the child’s guardian or by marrying the mother. In the very rare situations where those with parental responsibility appear to be making decisions that would not be in the child’s best interests (refusing medical treatment, for example) the courts can intervene to override a parent’s decision. A child can also decide on medical treatment for him or herself once s/he is 16 or younger if the doctor believes that s/he is able to understand the importance and consequences of such decisions. Child protection Under British law, however, parent’s rights exist to protect the welfare and development of the child. If these are threatened, or the parents cannot protect their children, then it is possible that the local authority social services would seek to take action. They will do so if they believe it is possible that the child is being physically abused • the child is being neglected (not properly fed or clothed or left alone or in charge of other children when too young to do so)

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•the child is being sexually abused or exploited If social services, health or education workers have reason to believe that a child needs protection then a social worker will become involved. She or he would make contact with the parents and child fi rst to assess the situation and then to offer support or to propose further action if it appears that the parents cannot or will not look after their children well enough. Contact with children Every child born to a married woman is presumed to be her husband’s child unless there is proof to the contrary. The husband has the right to enter his name on the child’s birth certificate, whether or not he is actually the father.If you separate, you and your partner may make an informal arrangement for contact with the child. If this is not possible, a court can be asked to intervene. The court order will usually allow contact between the child and the parent with whom the child is not living, unless there are exceptional circumstances. If this is difficult, it may be possible to get help from an access centre, where the visits would take place. Where a couple is cohabiting, a male partner is not presumed to be the father of a child. His name can only appear on the birth certificate if he registers the birth with the mother. This is regarded as proof of his paternity, and so he will be responsible for the financial support of the child, but does not give him any extra rights: for that he would need a court order or an agreement. Financial support of children Both parents are responsible for supporting the child financially. When a parent in the UK does not financially support a child, the Government’sChild Support Agency can step in to enforce payments. This is done according to a formula that takes the incomes and responsibilities of both parents into account. If the parent

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looking after the child is on benefits, the money so received will mostly be deducted from benefits. A parent with parental responsibility can claim a tax credit for the child, with extra credit available for certain types of child care expenses. In the benefits and tax system there are some allowances made for “single” or “lone” parents who are bringing up a child on their own. In particular, women with caring responsibilities may not have to sign on for work in order to get benefits. Appointing a Guardian for a child A parent can appoint a “guardian” who is someone who will take over parental responsibility if the parent dies. In the case of a married couple, either parent can appoint a guardian to act in the event of both parents dying. Where the parents are cohabiting, a mother can appoint a guardian to act on her death and a father can appoint a guardian to act on his death if he has parental responsibility for the child.

CODE OF GOOD PRACTICE ON THE PROTECTION OF EMPLOYEES DURING PREGNANCY AND AFTER THE BIRTH OF A CHILD

1. INTRODUCTION

1.1 Many women work during pregnancy and many return to work while they are still breast-feeding.

1.2 The objective of this code is to provide guidelines for employers and employees concerning the protection of the health of women against potential hazards in their work

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environment during pregnancy, after the birth of a child and while breast-feeding.

2. APPLICATION OF THE CODE

2.1 This code is issued in terms of section 87(1) (b) of the Basic Conditions of Employment Act (BCEA) 75 of 1997.

2.2 It is intended to guide all employers and employees concerning the application of section 26(1) of the BCEA which prohibits employers from requiring or permitting pregnant or breast-feeding employees to perform work that is hazardous to the health of the employee or that of her child.

2.3 Workplaces may be affected differently depending upon the type of business and sector they are engaged in and the physical, chemical and biological hazards to which employees may be exposed in the workplace.

2.4 The norms established by this code are general and may not be appropriate for all workplaces. A departure from the code may be justified in the proper circumstances. For example, the number of employees employed in an establishment may warrant a different approach.

3. CONTENTS

This code

3.1 sets out the legal requirements relevant to the protection of the health and safety of pregnant and breast-feeding employees;

3.2 sets out a method for assessing and controlling the risks to the health and safety of pregnant and breast-feeding employees;

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3.3 lists the principal physical, ergonomic, chemical and biological hazards to the health and safety of pregnant and breast-feeding employees and recommends steps to prevent or control these risks. These are listed in Schedules One to Four, which are included for guidance and are not exhaustive.

4. LEGAL REQUIREMENTS

4.1 The Constitution protects the right to bodily and psychological integrity, which includes the right to make decisions concerning reproduction [section 12(2)] and gives every person the right to health services, including reproductive health care [section 27(1)(a)].

4.2 No person may be discriminated against or dismissed on account of pregnancy.*

* The relevant provisions establishing this right are section 9(3) and (4) of the Constitution; section 187(1) of the Labour Relations Act 66 of 1995 and section 6 of the Employment Equity Act of 1998.

4.3 Employers are required to provide and maintain a work environment that is safe and without risk to the health of employees. This includes risks to the reproductive health of employees. These duties are established in terms of both the Occupational Health and Safety Act (OHSA) 85 of 1993 and the Mine Health and Safety Act (MHSA) 27 of 1996. Key aspects of these Acts are -

4.3.1 Employers must conduct a risk assessment, which involves identifying hazards, assessing the risk that they pose to the health and safety of employees. and recording the results of the risk assessment.

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4.3.2 Employers must implement appropriate measures to eliminate or control hazards identified in the risk assessment;

4.3.3 Employers must supply employees with information about and train them in the risks to their health and safety and the measures taken to eliminate or minimise them;

4.3.4 Elected worker health and safety representatives and committees are entitled to participate in the risk assessment and control of hazards;

4.3.5 Employees have a duty to take reasonable steps to protect their own health and safety and that of other employees.

5. PROTECTING THE HEALTH OF PREGNANT AND BREAST-FEEDING EMPLOYEES

5.1 Section 26(1) of the BCEA prohibits employers from requiring or permitting a pregnant employee or an employee who is breast-feeding to perform work that is hazardous to the health of the employee or the health of her child. This requires employers who employ women of childbearing age to assess and control risks to the health of pregnant or breast-feeding employees and that of the foetus or child.

5.2 Employers should identify, record and regularly review -

5.2.1 Potential risks to pregnant or breast-feeding employees within the workplace;

5.2.2 Protective measures and adjustments to working arrangements for pregnant or breast-feeding employees.

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5.3 Where appropriate, employers should also maintain a list of employment positions not involving risk to which pregnant or breast-feeding employees could be transferred.*

* In terms of section 26(2) of the BCEA an employer must offer suitable alternative employment to an employee during pregnancy if her work poses a danger to her health or safety or that of her child or if the employee is engaged in night work (between 18:00 and 06:00, unless it is not practicable to do so. Alternative employment must be on terms that are no less favourable than the employee's ordinary terms and conditions of employment.

5.4 Employers should inform employees about hazards to pregnant and breast feeding employees and of the importance of immediate notification of pregnancy.

5.5 Workplace policies should encourage women employees to inform employers of their pregnancy as early as possible to ensure that the employer is able to identify and assess risks and take appropriate preventive measures.

5.6 The employer should keep a record of every notification of pregnancy.

5.7 When an employee notifies an employer that she is pregnant her situation in the workplace should be evaluated. The evaluation should include -

5.7.1 An examination of the employee's physical condition by a qualified medical professional;

5.7.2 The employee's job;

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5.7.3 Workplace practices and potential workplace exposures that may affect the employee.

5.8 If the evaluation reveals that there is a risk to the health or safety of the pregnant employee or the foetus, the employer must -

5.8.1 Inform the employee of the risk;

5.8.2 After consulting the employee and her representative, if any, determine what steps should be taken to prevent the exposure of the employee to the risk by adjusting the employee's working conditions.

5.9 The employee should be given appropriate training in the hazards and the preventive measures taken.

5.10 If there is any uncertainty or concern about whether an employee's workstation or working conditions should be adjusted, it may be appropriate in certain circumstances to consult an occupational health practitioner. If appropriate adjustments cannot be made, the employee should be transferred to an alternative position in accordance with section 26(2) of the BCEA.

5.11 Employers must keep the risk assessment for expectant or new mothers under regular review. The possibility of damage to the health of the foetus may vary during the different stages of pregnancy. There are also different risks to consider for workers who are breast-feeding.

5.12 Arrangements should be made for pregnant and breast-feeding employees to be able to attend antenatal and postnatal clinics as required during pregnancy and after birth.

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5.13 Arrangements should be made for employees who are breast-feeding to have breaks of 30 minutes twice per day for breast-feeding or expressing milk each working day for the first six months of the child's life.

5.14 Where there is an occupational health service at a workplace, appropriate records should be kept of pregnancies and the outcome of pregnancies, including any complications in the condition of the employee or child.

Bibliography I. The World 2 Health Report 2005 mothers and children matter So does their health

II. Submission of the ACT Right to Life Association to the

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ACT Bill of Rights Consultative Committee

III Single Mother Assistance Article

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