Alyne da Silva Pimentel v. Brazil (Communication No. 17/2008)

Nature of the Case

Petition filed by the Center for Reproductive Rights and Advocacia Cidadã pelos Direitos Humanos before the Committee on the Elimination of All Forms of Discrimination Against Women to “ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary” under Art 12 (2) of the UN Convention; Scope of right to sexual and reproductive health in the context of maternal mortality; Non-discrimination and equality.

Summary

Alyne Pimentel, an Afro-Brazilian woman, died at 28 years old of complications resulting from her pregnancy, after a health center in Rio de Janeiro failed to provide for appropriate and timely access to emergency obstetric care. Pimentel’s death could have been prevented, if the health center had correctly diagnosed and treated her for intrauterine fetal death. Pimentel’s death is not an isolated case. As highlighted by the petitioner, citing a WHO survey, “4,000 maternal deaths occur each year in Brazil, representing one third of all maternal deaths in Latin America.” Moreover, a disproportionately high number of victims are among vulnerable groups, “especially women of African descent” (CEDAW, Concluding Observations on Brazil, August 2007).

The CEDAW Committee decided that the case was admissible due to “an unreasonably prolonged delay”, after 8 years passed without a definitive decision from the domestic court. On the merits, the CEDAW Committee found Brazil in violation of art.12 (2) of the CEDAW Convention and cited General Recommendation No. 28 (2010), which states “the policies of the State party must be action-and result-oriented as well as adequately funded” and that according to their General Recommendation 24, maximum available resources must be mobilized to ensure women’s right to safe motherhood and emergency obstetric services.   Therefore, the Committee found that the State violated the Convention in spite of its claims that it had made “qualified obstetric care” a priority in its National Plan for Women’s Policies. The Committee also affirmed that “the State is directly responsible for the action of private institutions when it outsources its medical services, and that furthermore, the State always maintains the duty to regulate and monitor private health-care institutions”.

The Committee recommendations noted that the State should ensure affordable access for all women to adequate emergency obstetric care and to effective judicial remedies. It also recommended the State provide adequate professional training for health workers, ensure compliance by private facilities with national and international standards in reproductive healthcare, and reduce preventable maternal deaths.

Keywords: Alyne da Silva Pimentel v. Brazil (Communication No. 17/2008), Poverty, Race, Discrimination, Gender, Woman

Enforcement of the Decision and Outcomes

The Committee established that the State should submit information to the Committee on any action taken regarding this case by February 2012.  It should also publish and disseminate the Committee’s views and recommendations in this case. In April 2013, the Brazilian government established an Interministerial Group (Portaria n. 35) with representatives of the Ministry of Health, the Ministry of Foreign Relations, the Secretary for Human Rights, the Secretary for Racial Equality and the Secretary on Gender Policies in order to implement the recommendations. In 2014, the Brazilian government agreed with the Committee that it would pay compensation to Alyne Pimentel’s mother. The compensation was paid during an official ceremony still in 2014 (Plataforma DHESCA Brasil, Relatorio sobre Mortalidade Materna, 2014. Available at: http://www.dhescbrasil.org.br/attachments/1010_missao_baixada_fluminense_dhssr.pdf).

Significance of the Case

This was the first case on maternal mortality to be brought before CEDAW. The Committee’s approach of referencing art 12 of ICESCR and General Comment 14 on the Right to Health developed by the ESCR Committee, in relation to capturing the scope of the rights and obligations at issue in this case was an important step forward in increasing coherence in international human rights law on women’s economic, social and cultural rights.   Further, the CEDAW Committee’s inclusion of factors affecting Alyne’s access to health services, such as poverty and race were an important step in further developing an intersectional understanding of women’s ESCR.

Groups Involved in the Case

Center for Reproductive Rights and Citizens’ Advocacy for Human Rights (ADVOCACI)