Answering the Millennium Call for the Right to Maternal Health: The Need to Eliminate User Fees

58 Pages Posted: 10 Sep 2013

See all articles by Margaux J. Hall

Margaux J. Hall

Columbia Law School; World Bank - Law and Justice (LEGAL)

Aziza Ahmed

Northeastern University - School of Law

Stephanie Swanson

Milbank, Tweed, Hadley & McCloy - New York Office; Harvard Law School

Date Written: 2009

Abstract

Complications during childbirth and pregnancy are a main source of death and disability among women of reproductive age. Approximately 536,000 women die from pregnancy-related complications each year. Developing countries suffer most profoundly, accounting for 99% of deaths. The world's nations, by endorsing U.N. Millennium Development Goals, recognized that most deaths are preventable; they have pledged to reduce maternal mortality by 75% by 2015. This Article assesses the barriers presented by user fees — formal charges for health services still charged by many countries — to the attainment of MDGs. It shows that user fees hamper healthcare access, particularly in emergency care settings, and fail in meeting their intended purposes of generating funds and improving equity, quality and decentralization of health care. The Article analyzes fees' adverse impact through a human rights lens that privileges each woman with an assessment of her health, unlike the MDGs which assess aggregate improvements and benchmarks. Finally, the Article explores alternatives to user fees, including universal health insurance schemes, tax schemes, and debt forgiveness programs and policies. It offers a guiding framework for assessing health financing systems — a framework that is centered on the needs of the poorest and most marginalized community members and that emphasizes accountability.

Keywords: maternal mortality, women, health, reproductive health, reproductive rights, user fees

Suggested Citation

Hall, Margaux Janine and Ahmed, Aziza and Swanson, Stephanie, Answering the Millennium Call for the Right to Maternal Health: The Need to Eliminate User Fees (2009). Yale Human Rights and Development Law Journal, Vol. 12, pp. 62-119, 2009. Available at SSRN: https://ssrn.com/abstract=1748942

Margaux Janine Hall (Contact Author)

Columbia Law School ( email )

435 West 116th Street
New York, NY 10025
United States

World Bank - Law and Justice (LEGAL) ( email )

1818 H Street, N.W.
Washington, DC 20433
United States

Aziza Ahmed

Northeastern University - School of Law ( email )

416 Huntington Avenue
Boston, MA 02115
United States

Stephanie Swanson

Milbank, Tweed, Hadley & McCloy - New York Office ( email )

1 Chase Manhattan Plaza
New York, NY 10005
United States

Harvard Law School

1563 Massachusetts Ave
Cambridge, MA 02138
United States

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